MEDICARE: SARAH ANN JANISH PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501019491	MI

General Provider Information

NPI Number	:	1053943464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ANN JANISH PT, DPT

Provider Business Mailing Address
First Line	:	9715 ELMS RD
Second Line	:
City	:	BIRCH RUN
State	:	MI
Zip	:	48415-8482
Country	:	US
Telephone Number	:	989-482-1799
Fax Number	:

Provider Business Practice Location Address
First Line	:	695 MITZI ST
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49445-3232
Country	:	US
Telephone Number	:	231-744-1641
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2020
Last Update Date	:	02/04/2020

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