Provider Demographics
NPI:1982931754
Name:CHIULLI, SARA JEAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JEAN
Last Name:CHIULLI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JEAN
Other - Last Name:ZAJAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:275 S MAIN ST
Mailing Address - Street 2:STE 208
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6461
Mailing Address - Country:US
Mailing Address - Phone:303-776-3800
Mailing Address - Fax:303-776-3806
Practice Address - Street 1:11575 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2780
Practice Address - Country:US
Practice Address - Phone:303-467-2288
Practice Address - Fax:303-410-0100
Is Sole Proprietor?:No
Enumeration Date:2009-11-15
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPT 10456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA103230Medicare PIN