Provider Demographics
NPI:1356460562
Name:LEGASSE, SARAH JUELLE (PTA)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:JUELLE
Last Name:LEGASSE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BRADY STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH WALPOLE
Mailing Address - State:NH
Mailing Address - Zip Code:03609
Mailing Address - Country:US
Mailing Address - Phone:603-445-2271
Mailing Address - Fax:
Practice Address - Street 1:8 BRADY ST
Practice Address - Street 2:
Practice Address - City:NORTH WALPOLE
Practice Address - State:NH
Practice Address - Zip Code:03609-1763
Practice Address - Country:US
Practice Address - Phone:603-445-2271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0410000490225200000X
NH0771225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant