Provider Demographics
NPI:1487041836
Name:MCDERMOTT, SARA M (PT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:M
Other - Last Name:TRUMBULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:991 S BATES ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009
Mailing Address - Country:US
Mailing Address - Phone:248-885-2308
Mailing Address - Fax:248-952-9185
Practice Address - Street 1:2136 ROBINSON RD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3558
Practice Address - Country:US
Practice Address - Phone:517-750-2540
Practice Address - Fax:517-750-2044
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist