Provider Demographics
NPI:1801495130
Name:SMITH, SARAH CORENA (ATC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:CORENA
Last Name:SMITH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 RIDGEVIEW DR APT 32
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-6206
Mailing Address - Country:US
Mailing Address - Phone:303-304-6047
Mailing Address - Fax:
Practice Address - Street 1:110 BISHOP MANOGUE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-4809
Practice Address - Country:US
Practice Address - Phone:303-304-6047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05063832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer