Healthcare Provider Details

I. General information

NPI: 1487748398
Provider Name (Legal Business Name): SARA ELIZABETH ALFORD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PINEHAVEN STREET EXT
LAURENS SC
29360-2671
US

IV. Provider business mailing address

3714 GRANDVIEW DR APT. 334 E
SIMPSONVILLE SC
29680-3720
US

V. Phone/Fax

Practice location:
  • Phone: 864-984-6584
  • Fax:
Mailing address:
  • Phone: 864-506-4118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1875
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: