Provider Demographics
NPI:1841467669
Name:PACKARD, SARA ESTELA (PTA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ESTELA
Last Name:PACKARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SKYRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5744
Mailing Address - Country:US
Mailing Address - Phone:530-889-9877
Mailing Address - Fax:
Practice Address - Street 1:366 ELM AVE STE 252
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4525
Practice Address - Country:US
Practice Address - Phone:530-889-9877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5751225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant