Healthcare Provider Details

I. General information

NPI: 1386215093
Provider Name (Legal Business Name): SAREYA HARVEY MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2021
Last Update Date: 07/20/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 COLISEUM DRIVE
TUSCALOOSA AL
35401
US

IV. Provider business mailing address

4114 LASTER LN
CALDWELL ID
83607-8052
US

V. Phone/Fax

Practice location:
  • Phone: 208-741-2450
  • Fax:
Mailing address:
  • Phone: 208-741-2450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2760
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: