Healthcare Provider Details

I. General information

NPI: 1396975892
Provider Name (Legal Business Name): SARAH HECK LYTHGOE LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7709 CRAIG CREEK RD
EAGLE ROCK VA
24085-3445
US

IV. Provider business mailing address

7709 CRAIG CREEK RD
EAGLE ROCK VA
24085-3445
US

V. Phone/Fax

Practice location:
  • Phone: 540-589-1568
  • Fax:
Mailing address:
  • Phone: 540-589-1568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306000404
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: