Provider Demographics
NPI:1962126342
Name:FLYNN, SAGE (DPT)
Entity type:Individual
Prefix:
First Name:SAGE
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1980 KETTNER BLVD APT 432
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2264
Mailing Address - Country:US
Mailing Address - Phone:949-244-7964
Mailing Address - Fax:858-810-0174
Practice Address - Street 1:11848 BERNARDO PLAZA CT STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2417
Practice Address - Country:US
Practice Address - Phone:858-217-2496
Practice Address - Fax:858-810-0174
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA302559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA302559OtherLICENSE