Provider Demographics
NPI:1952762627
Name:SMALL, SARI
Entity Type:Individual
Prefix:
First Name:SARI
Middle Name:
Last Name:SMALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7567 CENTRAL PARKE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6852
Mailing Address - Country:US
Mailing Address - Phone:513-701-6100
Mailing Address - Fax:513-701-6106
Practice Address - Street 1:9395 KENWOOD RD
Practice Address - Street 2:SUITE 107
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6819
Practice Address - Country:US
Practice Address - Phone:513-745-9877
Practice Address - Fax:513-745-0966
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10394225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH366632Medicare PIN