Provider Demographics
NPI:1336580331
Name:GRACE, SARAH LYNN (PTA)
Entity type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:LYNN
Last Name:GRACE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:39751 GREENVIEW PL APT 4
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4567
Mailing Address - Country:US
Mailing Address - Phone:734-353-8125
Mailing Address - Fax:
Practice Address - Street 1:39450 W 12 MILE ROAD
Practice Address - Street 2:SUITE 1A
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-0000
Practice Address - Country:US
Practice Address - Phone:248-344-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502003609225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant