Provider Demographics
NPI:1669111795
Name:SEIBOLD, SARAH MICHEL (PTA)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MICHEL
Last Name:SEIBOLD
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 1:1588 ETON WAY
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1526
Mailing Address - Country:US
Mailing Address - Phone:410-353-0302
Mailing Address - Fax:
Practice Address - Street 1:2200 DEFENSE HWY STE 200
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2927
Practice Address - Country:US
Practice Address - Phone:410-721-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2594225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant