Provider Demographics
NPI:1285367847
Name:EVANS, SARAH ROSE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ROSE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-3058
Mailing Address - Country:US
Mailing Address - Phone:501-326-7309
Mailing Address - Fax:
Practice Address - Street 1:6 W J SOWDER DRIVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72022
Practice Address - Country:US
Practice Address - Phone:501-450-3153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT9992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty