Basic Information
| Provider Information | |||||||||
| NPI: | 1568559847 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PURDY | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | MPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CHRISTOS | ||||||||
| OtherFirstName: | SARAH | ||||||||
| OtherMiddleName: | MICHELLE | ||||||||
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| OtherCredential: | MPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 24630 WASHINGTON AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925626131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516969353 | ||||||||
| FaxNumber: | 9519737216 | ||||||||
| Practice Location | |||||||||
| Address1: | 31764 CASINO DR | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | LAKE ELSINORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925304571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514713300 | ||||||||
| FaxNumber: | 9514713301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 04/03/2017 | ||||||||
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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 | PT29627 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.