Provider Demographics
NPI:1124431523
Name:ELLEFSON, SARAH KRISTINE (PT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KRISTINE
Last Name:ELLEFSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-0768
Mailing Address - Country:US
Mailing Address - Phone:970-829-4866
Mailing Address - Fax:970-360-2337
Practice Address - Street 1:160 W BEAVER CREEK BLVD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620-5422
Practice Address - Country:US
Practice Address - Phone:970-343-4688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist