Basic Information
Provider Information
NPI: 1316606510
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEWELL
FirstName: SARAH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 921 W BEACON ST
Address2:  
City: PHILADELPHIA
State: MS
PostalCode: 393503229
CountryCode: US
TelephoneNumber: 6016500002
FaxNumber: 6016509902
Practice Location
Address1: 322 HIGHWAY 80 E STE 10&11
Address2:  
City: CLINTON
State: MS
PostalCode: 390564726
CountryCode: US
TelephoneNumber: 6014600910
FaxNumber: 6014600911
Other Information
ProviderEnumerationDate: 12/15/2021
LastUpdateDate: 12/15/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/15/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT6459MSY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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