Healthcare Provider Details

I. General information

NPI: 1881073112
Provider Name (Legal Business Name): SARAH CAMPBELL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13197 CHURCH STREET
PIGEON FALLS WI
54760
US

IV. Provider business mailing address

W6449 LANGDELL RD
EAU CLAIRE WI
54701-9567
US

V. Phone/Fax

Practice location:
  • Phone: 715-579-5518
  • Fax:
Mailing address:
  • Phone: 715-579-5518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2036-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: