Provider Demographics
NPI:1073817722
Name:OMER, SANA HUSSAIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SANA
Middle Name:HUSSAIN
Last Name:OMER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BURR RIDGE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0845
Mailing Address - Country:US
Mailing Address - Phone:630-920-4670
Mailing Address - Fax:620-920-4687
Practice Address - Street 1:4430 FOX VALLEY CENTER DR STE 104
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504
Practice Address - Country:US
Practice Address - Phone:630-920-4670
Practice Address - Fax:630-920-4687
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.018238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208169003Medicare UPIN