MEDICARE: MRS. SARAH A STUMBO PT

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	4210	OK

General Provider Information

NPI Number	:	1780817767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH A STUMBO PT

Provider Business Mailing Address
First Line	:	3341 S ELM PL
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-7924
Country	:	US
Telephone Number	:	918-449-1332
Fax Number	:	918-449-8732

Provider Business Practice Location Address
First Line	:	3341 S ELM PL
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-7924
Country	:	US
Telephone Number	:	918-449-1332
Fax Number	:	918-449-8732

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

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	08/25/2009

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