Healthcare Provider Details

I. General information

NPI: 1073060885
Provider Name (Legal Business Name): SARA GRYGUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 JACK STEPHENS DR # B
LITTLE ROCK AR
72205-5551
US

IV. Provider business mailing address

501 JACK STEPHENS DR # B
LITTLE ROCK AR
72205-5551
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-5271
  • Fax:
Mailing address:
  • Phone: 501-686-5271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOTR3969
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: