Provider Demographics
NPI:1558671834
Name:SCOVITCH, SARA L (MPT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:SCOVITCH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:L
Other - Last Name:ANNABLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:11027 HAUGHS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:KEYMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21757-8765
Mailing Address - Country:US
Mailing Address - Phone:301-845-6811
Mailing Address - Fax:
Practice Address - Street 1:8965 GUILFORD RD
Practice Address - Street 2:SUITE 160
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2384
Practice Address - Country:US
Practice Address - Phone:301-706-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD197452251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics