Provider Demographics
NPI:1144642455
Name:VANCE, SARAH (PT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:VANCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 DAVIDSON GATEWAY DR APT 4
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-5510
Mailing Address - Country:US
Mailing Address - Phone:336-782-4742
Mailing Address - Fax:
Practice Address - Street 1:275 BEATTY DR
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-2715
Practice Address - Country:US
Practice Address - Phone:704-512-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist