Provider Demographics
NPI:1215484209
Name:BOURQUE, SARAH NATHERESE (PT, DPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:NATHERESE
Last Name:BOURQUE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 N NC 16 BUSINESS HWY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-8011
Mailing Address - Country:US
Mailing Address - Phone:704-483-0777
Mailing Address - Fax:704-483-1883
Practice Address - Street 1:9195 SHERRILLS FORD RD
Practice Address - Street 2:
Practice Address - City:SHERRILLS FORD
Practice Address - State:NC
Practice Address - Zip Code:28682
Practice Address - Country:US
Practice Address - Phone:704-483-0777
Practice Address - Fax:704-483-1883
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4120225100000X
NCCP000371T225100000X
NCP20291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist