Provider Demographics
NPI:1770077117
Name:CHANCELLOR, SARAH ANNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:CHANCELLOR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANNE
Other - Last Name:PHILPOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:589 WHITCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72718-8421
Mailing Address - Country:US
Mailing Address - Phone:479-387-1508
Mailing Address - Fax:
Practice Address - Street 1:5320 W SUNSET AVE STE 168
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-4410
Practice Address - Country:US
Practice Address - Phone:479-442-7473
Practice Address - Fax:479-239-5444
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR291049721Medicaid