Provider Demographics
NPI:1073529954
Name:WEIDMAN, SARAH ELIZABETH (MPT)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ELIZABETH
Last Name:WEIDMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:GARDINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1135 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-5702
Mailing Address - Country:US
Mailing Address - Phone:773-729-2551
Mailing Address - Fax:773-729-2556
Practice Address - Street 1:867 N HERMITAGE AVE
Practice Address - Street 2:#2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5018
Practice Address - Country:US
Practice Address - Phone:773-729-2551
Practice Address - Fax:773-729-2556
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070014334OtherLICENSE
IL070014334OtherLICENSE