Provider Demographics
NPI:1043351851
Name:EDER, SABRINA DIANNE (PT)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:DIANNE
Last Name:EDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 S ROLLING MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-1677
Mailing Address - Country:US
Mailing Address - Phone:414-248-6250
Mailing Address - Fax:
Practice Address - Street 1:7625 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-2112
Practice Address - Country:US
Practice Address - Phone:414-766-0277
Practice Address - Fax:414-766-0299
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6286024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36145700Medicaid
WI000101659Medicare PIN