Basic Information
| Provider Information | |||||||||
| NPI: | 1306832977 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLANDERS | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | GRAY | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6914 HOLABIRD AVE | ||||||||
| Address2: | |||||||||
| City: | DUNDALK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212221747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102845441 | ||||||||
| FaxNumber: | 4102845442 | ||||||||
| Practice Location | |||||||||
| Address1: | 23 CROSSROADS DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109989133 | ||||||||
| FaxNumber: | 4109989155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 07/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 22996 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 392729 | 01 | MVP | OTHER | 000921159003 | 01 | HEALTH NOW | OTHER | 000144937 | 01 | EXCELLUS BCBS | OTHER |