Provider Demographics
NPI:1316304348
Name:BURT, SARAH ANN (DPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:BURT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANN
Other - Last Name:GWIZDALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:205 W GRAND RIVER AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1659
Mailing Address - Country:US
Mailing Address - Phone:810-588-4133
Mailing Address - Fax:810-588-4124
Practice Address - Street 1:205 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1659
Practice Address - Country:US
Practice Address - Phone:810-588-4133
Practice Address - Fax:810-588-4124
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist