Provider Demographics
NPI:1295729150
Name:TAVARES, SARA S (PT, MSR, NCS)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:S
Last Name:TAVARES
Suffix:
Gender:F
Credentials:PT, MSR, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 VILLAGE SQ
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4625
Mailing Address - Country:US
Mailing Address - Phone:843-442-9369
Mailing Address - Fax:
Practice Address - Street 1:1514 MATHIS FERRY RD STE A104
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-9760
Practice Address - Country:US
Practice Address - Phone:843-442-9369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist