Provider Demographics
NPI:1215433883
Name:STUTZ, SARA MARTHA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MARTHA
Last Name:STUTZ
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1569 SOLANO AVE # 525
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2116
Mailing Address - Country:US
Mailing Address - Phone:510-375-5420
Mailing Address - Fax:510-280-2556
Practice Address - Street 1:752 ENSENADA AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-1809
Practice Address - Country:US
Practice Address - Phone:510-375-5420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT184102251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT18410OtherPHYSICAL THERAPY BOARD OF CALIFORNIA