Provider Demographics
NPI:1063789428
Name:GREGG, SARA (DPT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:GREGG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:MONATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:331 TILTON RD
Mailing Address - Street 2:STE 7
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1201
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:731 LACEY RD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1364
Practice Address - Country:US
Practice Address - Phone:609-242-6780
Practice Address - Fax:609-242-6783
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01425700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist