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General NPI Number Information
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NPI Number | 1336580331
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Entity Type | Individual
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Provider Name | SARAH LYNN GRACE PTA
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Gender | Female
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Dates
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Enumeration Date | 07/08/2013
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 39450 W 12 MILE ROAD SUITE 1A
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City | NOVI
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State | MI
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Zip | 48377-0000
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Country | US
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Telephone | 248-344-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 39751 GREENVIEW PL APT 4
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City | PLYMOUTH
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State | MI
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Zip | 48170-4567
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Country | US
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Telephone | 734-353-8125
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502003609
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License Number State | MI
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