Healthcare Provider Details

I. General information

NPI: 1629809355
Provider Name (Legal Business Name): SARAH ANN TELLAS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 CRILL AVE BLDG 3
PALATKA FL
32177-9231
US

IV. Provider business mailing address

PO BOX 932184
ATLANTA GA
31193-2184
US

V. Phone/Fax

Practice location:
  • Phone: 386-325-1119
  • Fax:
Mailing address:
  • Phone: 856-678-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT41889
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: