Provider Demographics
NPI:1134224868
Name:MOFFETT, SARAH VIRGINIA (PT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:VIRGINIA
Last Name:MOFFETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:VIRGINIA
Other - Last Name:MOFFETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 31630
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1630
Mailing Address - Country:US
Mailing Address - Phone:520-784-6200
Mailing Address - Fax:
Practice Address - Street 1:10350 E DREXEL RD UNIT 130
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9410
Practice Address - Country:US
Practice Address - Phone:520-784-6565
Practice Address - Fax:520-784-6454
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist