Healthcare Provider Details

I. General information

NPI: 1265175699
Provider Name (Legal Business Name): SARAH MARIE ANDERSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2026 CHENNAULT AVE
CLOVIS CA
93611-6887
US

IV. Provider business mailing address

2026 CHENNAULT AVE
CLOVIS CA
93611-6887
US

V. Phone/Fax

Practice location:
  • Phone: 559-283-2221
  • Fax:
Mailing address:
  • Phone: 559-283-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARAH ANDERSON
Title or Position: OWNER
Credential:
Phone: 559-283-2221