Provider Demographics
NPI:1063567097
Name:REID, SARAH BETH (PTA)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:BETH
Last Name:REID
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3308 W EDGEWOOD DR
Mailing Address - Street 2:F
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6891
Mailing Address - Country:US
Mailing Address - Phone:573-638-3400
Mailing Address - Fax:573-638-3405
Practice Address - Street 1:3308 W EDGEWOOD DR
Practice Address - Street 2:SUITE F
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6891
Practice Address - Country:US
Practice Address - Phone:573-638-3400
Practice Address - Fax:573-638-3405
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117810225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant