Basic Information
Provider Information
NPI: 1083118822
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAAGMAN
FirstName: SARAH
MiddleName: JANE
NamePrefix:  
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1111 LEFFINGWELL AVE NE
Address2:  
City: GRAND RAPIDS
State: MI
PostalCode: 495256406
CountryCode: US
TelephoneNumber: 6164597101
FaxNumber: 6164646170
Practice Location
Address1: 1111 LEFFINGWELL AVE NE
Address2:  
City: GRAND RAPIDS
State: MI
PostalCode: 495256406
CountryCode: US
TelephoneNumber: 6164597101
FaxNumber: 6164646170
Other Information
ProviderEnumerationDate: 03/19/2018
LastUpdateDate: 08/25/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/25/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X5501015707MIY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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