Provider Demographics
NPI:1316130826
Name:RAMIREZ, SARAH MARIE PROVENZANO (DPT)
Entity type:Individual
Prefix:
First Name:SARAH MARIE
Middle Name:PROVENZANO
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MARIE
Other - Last Name:PROVENZANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5050 WILKERSON RD BLDG 5000
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-9716
Mailing Address - Country:US
Mailing Address - Phone:713-818-3783
Mailing Address - Fax:
Practice Address - Street 1:TRAINING SITE 24
Practice Address - Street 2:CAMP AP TACP FTU
Practice Address - City:CAMP BULLIS
Practice Address - State:TX
Practice Address - Zip Code:78257
Practice Address - Country:US
Practice Address - Phone:713-818-3783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1157893225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist