Healthcare Provider Details

I. General information

NPI: 1740371707
Provider Name (Legal Business Name): SARA LYNN BROADWELL PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 MASON ST
MORRISONVILLE NY
12962-2700
US

IV. Provider business mailing address

882 MASON ST
MORRISONVILLE NY
12962-2700
US

V. Phone/Fax

Practice location:
  • Phone: 518-561-6888
  • Fax:
Mailing address:
  • Phone: 518-561-6888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number008917-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: