Provider Demographics
NPI:1487007779
Name:FURTADO, SARA (LAT, ATC)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:FURTADO
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:5143 WILDFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-2154
Mailing Address - Country:US
Mailing Address - Phone:210-865-5144
Mailing Address - Fax:
Practice Address - Street 1:811 FABULOUS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3410
Practice Address - Country:US
Practice Address - Phone:210-000-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT57482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer