Provider Demographics
NPI:1295427102
Name:STAKES, SARAH ELIZABETH (LAT, ATC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:STAKES
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17610 FAIRWAY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:KLEIN
Mailing Address - State:TX
Mailing Address - Zip Code:77379-4210
Mailing Address - Country:US
Mailing Address - Phone:832-474-8465
Mailing Address - Fax:
Practice Address - Street 1:17610 FAIRWAY OAKS DR
Practice Address - Street 2:
Practice Address - City:KLEIN
Practice Address - State:TX
Practice Address - Zip Code:77379-4210
Practice Address - Country:US
Practice Address - Phone:832-474-8465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT87442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer