Provider Demographics
NPI:1871013490
Name:GARDNER, SARAH FALLON (DPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:FALLON
Last Name:GARDNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:BREANNE
Other - Last Name:FALLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:
Mailing Address - City:DANIEL
Mailing Address - State:WY
Mailing Address - Zip Code:83115-0196
Mailing Address - Country:US
Mailing Address - Phone:307-690-5772
Mailing Address - Fax:
Practice Address - Street 1:231 N FRONT ST UNIT A
Practice Address - Street 2:
Practice Address - City:BIG PINEY
Practice Address - State:WY
Practice Address - Zip Code:83113-5131
Practice Address - Country:US
Practice Address - Phone:307-276-0038
Practice Address - Fax:307-276-0087
Is Sole Proprietor?:No
Enumeration Date:2017-06-24
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1785225100000X
UT10380431-2401225100000X
CA293531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist