1710121835 NPI number — MRS. SARAH SNYDER DIEHL P.T.

Table of content: MRS. SARAH SNYDER DIEHL P.T. (NPI 1710121835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710121835 NPI number — MRS. SARAH SNYDER DIEHL P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIEHL
Provider First Name:
SARAH
Provider Middle Name:
SNYDER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SNYDER
Provider Other First Name:
SARAH
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710121835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 WOODLYN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YADKINVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27055-6673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-677-1800
Provider Business Mailing Address Fax Number:
336-677-1802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 WOODLYN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YADKINVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27055-6673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-677-1800
Provider Business Practice Location Address Fax Number:
336-677-1802
Provider Enumeration Date:
04/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2402 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7213005 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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