Provider Demographics
NPI:1831612092
Name:GROSS, SARA WEBER (LAT, ATC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:WEBER
Last Name:GROSS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 BETHEL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-9084
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:156 RAIDER RD
Practice Address - Street 2:
Practice Address - City:OLIN
Practice Address - State:NC
Practice Address - Zip Code:28660-9454
Practice Address - Country:US
Practice Address - Phone:704-876-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer