Provider Demographics
NPI:1316117062
Name:ELLERBE, SARA E
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:ELLERBE
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 1:800 FAIRMOUNT AVE
Mailing Address - Street 2:SUITE 322
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3150
Mailing Address - Country:US
Mailing Address - Phone:626-795-8023
Mailing Address - Fax:626-628-2194
Practice Address - Street 1:800 FAIRMOUNT AVE
Practice Address - Street 2:SUITE 322
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3150
Practice Address - Country:US
Practice Address - Phone:626-795-8023
Practice Address - Fax:626-628-2194
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7858A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT7858AMedicare PIN