Provider Demographics
NPI:1144303017
Name:PFEIFER, SARA LEILANI
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LEILANI
Last Name:PFEIFER
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 1:2284 JAROSA LN
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8240
Mailing Address - Country:US
Mailing Address - Phone:303-499-0480
Mailing Address - Fax:
Practice Address - Street 1:5412 IDYLWILD TRL
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3571
Practice Address - Country:US
Practice Address - Phone:303-530-1503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO77671244Medicaid