Healthcare Provider Details

I. General information

NPI: 1366373656
Provider Name (Legal Business Name): SARA SAMPSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA MIETTE LEGRAND

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 S BROWNELL RD STE 10
WILLISTON VT
05495-7415
US

IV. Provider business mailing address

29 DUBOIS DR
SOUTH BURLINGTON VT
05403-7641
US

V. Phone/Fax

Practice location:
  • Phone: 802-448-5158
  • Fax:
Mailing address:
  • Phone: 206-402-8498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040.0135055PROV
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: