Healthcare Provider Details

I. General information

NPI: 1215907407
Provider Name (Legal Business Name): SARA J LOKAN M.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3293 MAIN ST
MAMMOTH LAKES CA
93546
US

IV. Provider business mailing address

PO BOX 7694
MAMMOTH LAKES CA
93546-7694
US

V. Phone/Fax

Practice location:
  • Phone: 831-924-0223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT21313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: