Provider Demographics
NPI:1952774309
Name:SADLER, JERROD MAXWELL (MS, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JERROD
Middle Name:MAXWELL
Last Name:SADLER
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CROYDON PL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9765
Mailing Address - Country:US
Mailing Address - Phone:919-478-0941
Mailing Address - Fax:
Practice Address - Street 1:1801 FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3129
Practice Address - Country:US
Practice Address - Phone:919-530-7595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2255A2300X
TXAT66962255A2300X
NCLAT39852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer