Provider Demographics
NPI:1548439201
Name:SANTORIELLO, SARAH LYNN (DPT)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:LYNN
Last Name:SANTORIELLO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:LYNN
Other - Last Name:DEANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5330 NE PRESCOTT ST.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218
Mailing Address - Country:US
Mailing Address - Phone:503-288-6585
Mailing Address - Fax:518-251-4207
Practice Address - Street 1:5330 NE PRESCOTT ST.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218
Practice Address - Country:US
Practice Address - Phone:503-288-6585
Practice Address - Fax:518-251-4207
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029942-1225100000X
OR06759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY335429Medicare PIN