Basic Information
| Provider Information | |||||||||
| NPI: | 1184842502 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | PHILLIPS | ||||||||
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| Credential: | A.T.C., P.T.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 DANIELS RD. | ||||||||
| Address2: | |||||||||
| City: | EAST HADDAM | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608732762 | ||||||||
| FaxNumber: | 2036303600 | ||||||||
| Practice Location | |||||||||
| Address1: | 1064 EAST MAIN ST. | ||||||||
| Address2: | |||||||||
| City: | MERIDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032359622 | ||||||||
| FaxNumber: | 2036303600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 000960 | CT | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 2255A2300X | 000149 | CT | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.