Healthcare Provider Details

I. General information

NPI: 1760664924
Provider Name (Legal Business Name): SARAH KIRACOFE LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FAIRVIEW AVE
CLIFTON FORGE VA
24422-1873
US

IV. Provider business mailing address

1110 POTTS CREEK RD
COVINGTON VA
24426-6908
US

V. Phone/Fax

Practice location:
  • Phone: 540-862-9555
  • Fax: 540-863-9981
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306602226
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: