Provider Demographics
NPI:1184912917
Name:PARKS, SARAH LEANNE (PT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LEANNE
Last Name:PARKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4701
Mailing Address - Country:US
Mailing Address - Phone:330-603-8802
Mailing Address - Fax:
Practice Address - Street 1:3148 BROADWAY
Practice Address - Street 2:SUITE 302
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-1781
Practice Address - Country:US
Practice Address - Phone:614-539-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH013144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist