Provider Demographics
NPI:1003502733
Name:BURD, SARA ANN (DPT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:BURD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANN
Other - Last Name:BERNARDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 KIMBERLY
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362-1055
Mailing Address - Country:US
Mailing Address - Phone:815-878-9808
Mailing Address - Fax:
Practice Address - Street 1:1401 E 12TH ST
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:IL
Practice Address - Zip Code:61342-9216
Practice Address - Country:US
Practice Address - Phone:815-539-7461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020099208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation