Provider Demographics
NPI:1548701824
Name:GILLETTE, SARAH E (PT, DPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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:757-873-2306
Practice Address - Street 1:250 W BRAMBLETON AVE STE 100
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1542
Practice Address - Country:US
Practice Address - Phone:757-938-6608
Practice Address - Fax:757-938-6611
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ56526AOtherMEDICARE PTAN
VAC05954OtherMEDICARE GROUP PTAN
VA1548701824Medicaid