Provider Demographics
NPI:1801140496
Name:NILSON, SARAH ANN (DPT)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ANN
Last Name:NILSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:ANN
Other - Last Name:RENVILLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:453 COWBOY WAY
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:ID
Mailing Address - Zip Code:83801-6027
Mailing Address - Country:US
Mailing Address - Phone:208-301-2935
Mailing Address - Fax:
Practice Address - Street 1:2514 N 7TH ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3720
Practice Address - Country:US
Practice Address - Phone:208-664-8128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-03
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist