Provider Demographics
NPI:1831234020
Name:TACKETT, SARAH (ATC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:TACKETT
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 1:3715 W BARSTOW AVE
Mailing Address - Street 2:238
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6664
Mailing Address - Country:US
Mailing Address - Phone:918-231-0511
Mailing Address - Fax:
Practice Address - Street 1:1620 E BULLDOG LN
Practice Address - Street 2:MS OF87
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93740-0001
Practice Address - Country:US
Practice Address - Phone:559-278-4170
Practice Address - Fax:559-278-8355
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer