MEDICARE: DR. SARA E. BOLDEN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT008248	GA

General Provider Information

NPI Number	:	1265572952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA E. BOLDEN DPT

Provider Business Mailing Address
First Line	:	3233 S CHEROKEE LN BLDG 1000
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-4461
Country	:	US
Telephone Number	:	770-485-7411
Fax Number	:	770-881-8506

Provider Business Practice Location Address
First Line	:	3233 S CHEROKEE LN BLDG 1000
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-4461
Country	:	US
Telephone Number	:	770-485-7411
Fax Number	:	770-881-8506

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/01/2021

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