Provider Demographics
NPI:1366943508
Name:NOLEN, SARAH BETH (PT, DPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:NOLEN
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 1:2600 GRACY FARMS LN APT 1228
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2920
Mailing Address - Country:US
Mailing Address - Phone:970-380-8839
Mailing Address - Fax:
Practice Address - Street 1:1825 FORTVIEW RD STE 109
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7655
Practice Address - Country:US
Practice Address - Phone:512-892-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1301736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist