Provider Demographics
NPI:1053702068
Name:ANSARI, SARA (DPT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ANSARI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 GAINSBOROUGH ST APT 408
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6537
Mailing Address - Country:US
Mailing Address - Phone:617-992-8782
Mailing Address - Fax:617-380-4006
Practice Address - Street 1:87 GAINSBOROUGH ST APT 408
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6537
Practice Address - Country:US
Practice Address - Phone:617-992-8782
Practice Address - Fax:617-380-4006
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist