Provider Demographics
NPI:1114408473
Name:FYOCK, SARAH LORRAINE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:LORRAINE
Last Name:FYOCK
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 1:1713 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4009
Mailing Address - Country:US
Mailing Address - Phone:724-812-2013
Mailing Address - Fax:
Practice Address - Street 1:1713 W 13TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4009
Practice Address - Country:US
Practice Address - Phone:724-812-2013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023763225100000X
DEJ1-0004229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist