Healthcare Provider Details

I. General information

NPI: 1467525113
Provider Name (Legal Business Name): SARA R TREADWELL P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53-59 PUBLIC SQUARE SUITE 101
WATERTOWN NY
13601-2603
US

IV. Provider business mailing address

53-59 PUBLIC SQUARE SUITE 101
WATERTOWN NY
13601-2603
US

V. Phone/Fax

Practice location:
  • Phone: 315-782-7872
  • Fax: 315-782-7871
Mailing address:
  • Phone: 315-782-7872
  • Fax: 315-782-7871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number003497-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0034971
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: