Provider Demographics
NPI:1780153478
Name:HEINRICH, SARAH ELIZABETH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:HEINRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:EMERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9117 KILBURY AVE NW
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55302-2945
Mailing Address - Country:US
Mailing Address - Phone:320-761-6303
Mailing Address - Fax:
Practice Address - Street 1:402 RED RIVER AVE N STE 6
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:MN
Practice Address - Zip Code:56320-1523
Practice Address - Country:US
Practice Address - Phone:320-685-7269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-25
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist