MEDICARE: SARAH ELIZABETH FAIRWEATHER

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	11381222-2401	UT
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1538710074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ELIZABETH FAIRWEATHER

Provider Business Mailing Address
First Line	:	27 S MARIO CAPECCHI DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5888
Country	:	US
Telephone Number	:	347-409-0042
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 S MARIO CAPECCHI DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5888
Country	:	US
Telephone Number	:	347-409-0042
Fax Number	:

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

Provider Enumeration Date	:	09/25/2019
Last Update Date	:	07/23/2025

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