Provider Demographics
NPI:1205074986
Name:ROBERTS, SARA ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:GHASSEMIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:
Practice Address - Street 1:704 N JUDD PKWY NE STE 100
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-1989
Practice Address - Country:US
Practice Address - Phone:919-896-7158
Practice Address - Fax:919-896-7208
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009875225100000X
SC5654225100000X
NCP18710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116819OtherMEDICARE REHABILITATION AGENCY CERTIFICATION NUMBER
SC426619OtherMEDICARE REHABILITATION AGENCY CERTIFICATION NUMBER