Provider Demographics
NPI:1912104688
Name:DEMOVILLE, SARAH COCKRELL (PT)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:COCKRELL
Last Name:DEMOVILLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 COLBERT LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4503
Mailing Address - Country:US
Mailing Address - Phone:904-495-2912
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:650 COLBERT LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4503
Practice Address - Country:US
Practice Address - Phone:904-495-2912
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154823225100000X
FL30531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L19423Medicare PIN