Healthcare Provider Details

I. General information

NPI: 1902367071
Provider Name (Legal Business Name): SARAH K ANDERSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 OLD PARSONAGE RD
SUMMERVILLE SC
29483-3343
US

IV. Provider business mailing address

222 OLD PARSONAGE RD
SUMMERVILLE SC
29483-3343
US

V. Phone/Fax

Practice location:
  • Phone: 843-870-7855
  • Fax: 855-232-8604
Mailing address:
  • Phone: 843-870-7855
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2249
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: