Provider Demographics
NPI:1235726001
Name:DURICA, SARAH (PTA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:DURICA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21733 W BONNIE LN
Mailing Address - Street 2:
Mailing Address - City:LANNON
Mailing Address - State:WI
Mailing Address - Zip Code:53046-9726
Mailing Address - Country:US
Mailing Address - Phone:262-993-1989
Mailing Address - Fax:
Practice Address - Street 1:3540 S 43RD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-1502
Practice Address - Country:US
Practice Address - Phone:414-541-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3036-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant