Healthcare Provider Details

I. General information

NPI: 1356635148
Provider Name (Legal Business Name): SARA MARGARET VOGELPOHL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 COMMONWEALTH AVE
WARWICK RI
02886-2707
US

IV. Provider business mailing address

54 FAIRVIEW AVE
WESTERLY RI
02891-2751
US

V. Phone/Fax

Practice location:
  • Phone: 401-691-4729
  • Fax:
Mailing address:
  • Phone: 401-573-2889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberRI00732
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: