Basic Information
Provider Information
NPI: 1003002940
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAURER
FirstName: SARAH
MiddleName: AMY FOX
NamePrefix: MRS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 650 ELLIS OAK DR
Address2:  
City: CHARLESTON
State: SC
PostalCode: 294123090
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 650 ELLIS OAK DR
Address2:  
City: CHARLESTON
State: SC
PostalCode: 294123090
CountryCode: US
TelephoneNumber: 8432661540
FaxNumber: 8432661567
Other Information
ProviderEnumerationDate: 09/24/2007
LastUpdateDate: 01/04/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251X0800X4304SCY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic

No ID Information.


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