Individual
SARAH MARIE PRIDEMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1401 PHAY AVE, CANON CITY, CO 81212-2303
(719) 275-8656
Mailing address
1401 PHAY AVE, CANON CITY, CO 81212-2303
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PTA.0014520
CO
Other
Enumeration date
08/21/2019
Last updated
08/21/2019
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