Provider Demographics
NPI:1215935911
Name:HASTY, SARA L (PT)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:L
Last Name:HASTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 SOUTH RANGE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701
Mailing Address - Country:US
Mailing Address - Phone:785-460-7848
Mailing Address - Fax:785-460-7849
Practice Address - Street 1:990 SOUTH RANGE
Practice Address - Street 2:SUITE 8
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701
Practice Address - Country:US
Practice Address - Phone:785-460-7848
Practice Address - Fax:785-460-7849
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11000847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS140698OtherBCBS
KS140698OtherBCBS