Provider Demographics
NPI:1114111564
Name:HASBROUCK, SARAH ALEXIS (DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ALEXIS
Last Name:HASBROUCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 NEW BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02770-4116
Mailing Address - Country:US
Mailing Address - Phone:631-965-7279
Mailing Address - Fax:
Practice Address - Street 1:541 NEW BEDFORD RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02770-4116
Practice Address - Country:US
Practice Address - Phone:631-965-7279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist