Healthcare Provider Details

I. General information

NPI: 1386213841
Provider Name (Legal Business Name): SARA ANN HUFFMAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA ANN CORRAL

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MEADOWOOD ST
GREENSBORO NC
27409-2838
US

IV. Provider business mailing address

1521 BRIDFORD PKWY # PRKW14F
GREENSBORO NC
27407-2503
US

V. Phone/Fax

Practice location:
  • Phone: 336-299-4400
  • Fax:
Mailing address:
  • Phone: 336-420-6860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA7454
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: