Provider Demographics
NPI:1619284403
Name:HOLT TRUNK, SARAH (PT, DPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:HOLT TRUNK
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 1:406 GOWER BAE
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:WI
Mailing Address - Zip Code:53183-9603
Mailing Address - Country:US
Mailing Address - Phone:262-442-5054
Mailing Address - Fax:262-314-1137
Practice Address - Street 1:524 MILWAUKEE ST STE 308
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-1461
Practice Address - Country:US
Practice Address - Phone:262-264-8701
Practice Address - Fax:262-314-1137
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist