Provider Demographics
NPI:1588114466
Name:NUECHTERLEIN, SARA ELIZABETH (MED, LAT, ATC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:NUECHTERLEIN
Suffix:
Gender:F
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 HIGH COTTON TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-5086
Mailing Address - Country:US
Mailing Address - Phone:682-564-8771
Mailing Address - Fax:
Practice Address - Street 1:4525 HIGH COTTON TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-5086
Practice Address - Country:US
Practice Address - Phone:682-564-8771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT64732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer