Provider Demographics
NPI:1861971996
Name:BURGETT, SARA (DPT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BURGETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7340 S ALTON WAY
Mailing Address - Street 2:STE 11-D
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2323
Mailing Address - Country:US
Mailing Address - Phone:720-493-1181
Mailing Address - Fax:720-493-1191
Practice Address - Street 1:111 WILLARD ST STE 2A
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1274
Practice Address - Country:US
Practice Address - Phone:617-770-0022
Practice Address - Fax:617-471-1114
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO16559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110138832AMedicaid