Provider Demographics
NPI:1255392130
Name:HARRIS, SARA DIANE (PT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:DIANE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:DIANE
Other - Last Name:LITHERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1900 SAINT CHARLES STREET
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9145
Mailing Address - Country:US
Mailing Address - Phone:812-634-1211
Mailing Address - Fax:812-634-1582
Practice Address - Street 1:1900 SAINT CHARLES STREET
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9145
Practice Address - Country:US
Practice Address - Phone:812-634-1211
Practice Address - Fax:812-634-1582
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005651A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCH1472Medicare PIN
IN0682120001Medicare NSC
IN215020DMedicare ID - Type UnspecifiedGROUP #