Healthcare Provider Details

I. General information

NPI: 1336815539
Provider Name (Legal Business Name): SARAH JEAN POWNER PT, DPT, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 W 34TH ST STE 450
LOS ANGELES CA
90089-3603
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 800-872-2273
  • Fax:
Mailing address:
  • Phone: 323-865-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number300338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: