Provider Demographics
NPI:1932805546
Name:CLARK, SARA JANE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:CLARK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10235 TALL OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7731
Mailing Address - Country:US
Mailing Address - Phone:303-882-4334
Mailing Address - Fax:
Practice Address - Street 1:7400 E HAMPDEN AVE UNIT C-3
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4861
Practice Address - Country:US
Practice Address - Phone:303-221-1474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0018332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist