MEDICARE: SARAH RENEE EADS 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	1218209	TX

General Provider Information

NPI Number	:	1598026502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH RENEE EADS DPT

Provider Business Mailing Address
First Line	:	4730 SHAVANO OAK STE 205
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-4029
Country	:	US
Telephone Number	:	210-526-2428
Fax Number	:	210-561-7121

Provider Business Practice Location Address
First Line	:	4730 SHAVANO OAK STE 205
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-4029
Country	:	US
Telephone Number	:	210-526-2428
Fax Number	:	210-817-8684

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

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	02/08/2022

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