Provider Demographics
NPI:1801262944
Name:LEATHERS, SARAH M (PT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:LEATHERS
Suffix:
Gender:F
Credentials:PT
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Other - First Name:
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Mailing Address - Street 1:3111 124TH AVE NW
Mailing Address - Street 2:SUITE 123
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-4572
Mailing Address - Country:US
Mailing Address - Phone:763-236-7358
Mailing Address - Fax:763-236-8966
Practice Address - Street 1:3111 124TH AVE NW
Practice Address - Street 2:SUITE 123
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-4572
Practice Address - Country:US
Practice Address - Phone:763-236-7358
Practice Address - Fax:763-236-8966
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN74782251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics