=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386875052
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICAL SARAH-PY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2009
-----------------------------------------------------
Last Update Date | 01/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 239 BONITA AVE
-----------------------------------------------------
City | PACIFICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94044-3116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-699-6854
-----------------------------------------------------
Fax | 270-513-7454
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 239 BONITA AVE
-----------------------------------------------------
City | PACIFICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94044-3116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-699-6854
-----------------------------------------------------
Fax | 270-513-7454
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST, OWNER
-----------------------------------------------------
Name | SARAH MICHELE NORTHROP
-----------------------------------------------------
Credential | M.P.T.
-----------------------------------------------------
Telephone | 415-699-6854
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | PT 25837
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------