Provider Demographics
NPI:1609750397
Name:FORTUNATO, SARA VIRGINIA (PTA, CLT, LMT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:VIRGINIA
Last Name:FORTUNATO
Suffix:
Gender:F
Credentials:PTA, CLT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 WYNDOM TER
Mailing Address - Street 2:
Mailing Address - City:HOLMES
Mailing Address - State:PA
Mailing Address - Zip Code:19043-1126
Mailing Address - Country:US
Mailing Address - Phone:610-324-6140
Mailing Address - Fax:
Practice Address - Street 1:115 S PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086-6333
Practice Address - Country:US
Practice Address - Phone:610-565-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant