Healthcare Provider Details

I. General information

NPI: 1568784460
Provider Name (Legal Business Name): SARAH SHARON GAW MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N PARKSIDE DR SUITE 201
COLORADO SPRINGS CO
80909-6097
US

IV. Provider business mailing address

3455 BEECHWOOD CT
COLORADO SPRINGS CO
80918-6415
US

V. Phone/Fax

Practice location:
  • Phone: 719-577-9190
  • Fax: 719-785-3798
Mailing address:
  • Phone: 719-494-6446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number8037
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: