MEDICARE: SARAH PETTYJOHN

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

General Provider Information

NPI Number	:	1366656118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH PETTYJOHN

Provider Business Mailing Address
First Line	:	3064 COVINGTON ST
Second Line	:	SUITE 104
City	:	RAPID CITY
State	:	SD
Zip	:	57703-7207
Country	:	US
Telephone Number	:	605-787-2719
Fax Number	:	605-718-4452

Provider Business Practice Location Address
First Line	:	3064 COVINGTON ST
Second Line	:	SUITE 104
City	:	RAPID CITY
State	:	SD
Zip	:	57703-7207
Country	:	US
Telephone Number	:	605-787-2719
Fax Number	:	605-718-4452

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	12/04/2015

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Directions to “ SARAH PETTYJOHN ” Practice Location

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