Provider Demographics
NPI:1306306758
Name:HOLMGREN, SARAH KATHERINE (PT, DPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHERINE
Last Name:HOLMGREN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 RALSTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7844
Mailing Address - Country:US
Mailing Address - Phone:805-804-4168
Mailing Address - Fax:805-830-1177
Practice Address - Street 1:2221 WANKEL WAY
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0192
Practice Address - Country:US
Practice Address - Phone:805-988-0448
Practice Address - Fax:805-988-3070
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.00161902251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPTL.0016190OtherSTATE LICENSE
CA300429OtherSTATE LICENSE