Healthcare Provider Details

I. General information

NPI: 1659533826
Provider Name (Legal Business Name): SARA KRISTINE PRIFOGLE MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 WINDING WAY
BATESVILLE IN
47006-7652
US

IV. Provider business mailing address

295 WINDING WAY
BATESVILLE IN
47006-7652
US

V. Phone/Fax

Practice location:
  • Phone: 812-932-3224
  • Fax: 812-932-3229
Mailing address:
  • Phone: 812-932-3224
  • Fax: 812-932-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05008234A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: