Healthcare Provider Details

I. General information

NPI: 1467550822
Provider Name (Legal Business Name): SARAH ANN MCCLOUD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 S WAKEA AVE.
KAHULUI HI
96732
US

IV. Provider business mailing address

161 S WAKEA AVE.
KAHULUI HI
96732
US

V. Phone/Fax

Practice location:
  • Phone: 360-532-0544
  • Fax: 360-532-0559
Mailing address:
  • Phone: 360-289-0251
  • Fax: 360-289-3226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00010021
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3603
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: