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General NPI Number Information
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NPI Number | 1023622289
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Entity Type | Individual
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Provider Name | SARA DESMARAIS DPT
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Gender | Female
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 2760 TRICOM ST
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406
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Country | US
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Telephone | 843-300-8585
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Fax |
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Provider Business Mailing Address
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Address Line | 9047 MAPLE GROVE DR
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8889
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Country | US
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Telephone | 513-884-0479
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 10393
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License Number State | SC
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