Provider Demographics
NPI:1861584567
Name:FENWICK, SARAH CAMILLE (DPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:CAMILLE
Last Name:FENWICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:CAMILLE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13989 SILVER STREAM DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8987
Mailing Address - Country:US
Mailing Address - Phone:317-701-3787
Mailing Address - Fax:
Practice Address - Street 1:13989 SILVER STREAM DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8987
Practice Address - Country:US
Practice Address - Phone:317-701-3787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN5009051A2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic