Provider Demographics
NPI:1346297363
Name:PITTELKAU, SARA YVONNE (MA, LAT, ATC)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:YVONNE
Last Name:PITTELKAU
Suffix:
Gender:F
Credentials:MA, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 WHITECHAPEL ARCH
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-4018
Mailing Address - Country:US
Mailing Address - Phone:252-258-9821
Mailing Address - Fax:
Practice Address - Street 1:3706 WHITECHAPEL ARCH
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-4018
Practice Address - Country:US
Practice Address - Phone:252-258-9821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11562255A2300X
VA01260008022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer