Provider Demographics
NPI:1215771308
Name:GROSSNIKLAUS, SARA ANN BAYAN
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANN BAYAN
Last Name:GROSSNIKLAUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10981 WINDJAMMER DR N
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-9672
Mailing Address - Country:US
Mailing Address - Phone:317-407-0673
Mailing Address - Fax:
Practice Address - Street 1:219 E 7TH ST APT 210
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-3577
Practice Address - Country:US
Practice Address - Phone:317-407-0673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer