Provider Demographics
NPI:1265764492
Name:SOUTHALL, SARAH E (PT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:SOUTHALL
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 1:2760 TRICOM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9169
Mailing Address - Country:US
Mailing Address - Phone:843-300-8585
Mailing Address - Fax:
Practice Address - Street 1:1010 ANNA KNAPP EXT
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5400
Practice Address - Country:US
Practice Address - Phone:843-971-1920
Practice Address - Fax:843-971-1920
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist