Provider Demographics
NPI:1720153042
Name:MERRILL, SARA HATHEWAY (MPT)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:HATHEWAY
Last Name:MERRILL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:WOOD
Other - Last Name:HATHEWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:SCARBOROUGH PHYSICAL THERAPY ASSOCIATES
Mailing Address - Street 2:69 US ROUTE ONE
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-883-1227
Mailing Address - Fax:207-883-6199
Practice Address - Street 1:SCARBOROUGH PHYSICAL THERAPY ASSOCIATES
Practice Address - Street 2:69 US ROUTE ONE
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-883-1227
Practice Address - Fax:207-883-6199
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME018401OtherANTHEM
ME018401OtherANTHEM