Provider Demographics
NPI:1336580331
Name:GRACE, SARAH LYNN (PTA)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:LYNN
Last Name:GRACE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
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Mailing Address - Street 1:9243 KNOLSON ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3344
Mailing Address - Country:US
Mailing Address - Phone:734-353-8125
Mailing Address - Fax:248-565-4030
Practice Address - Street 1:1647 INKSTER RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-3086
Practice Address - Country:US
Practice Address - Phone:734-261-2000
Practice Address - Fax:734-261-2009
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5502003609225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant