Healthcare Provider Details

I. General information

NPI: 1861584567
Provider Name (Legal Business Name): SARAH CAMILLE FENWICK D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH CAMILLE WILSON

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13989 SILVER STREAM DR
CARMEL IN
46032-8987
US

IV. Provider business mailing address

13989 SILVER STREAM DR
CARMEL IN
46032-8987
US

V. Phone/Fax

Practice location:
  • Phone: 317-701-3787
  • Fax:
Mailing address:
  • Phone: 317-701-3787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5009051A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: