Provider Demographics
NPI:1275832792
Name:SARDON, ROGER T (PT)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:T
Last Name:SARDON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 W. PERSHING
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LYONS
Mailing Address - State:IL
Mailing Address - Zip Code:60534-0288
Mailing Address - Country:US
Mailing Address - Phone:708-447-9616
Mailing Address - Fax:708-447-9626
Practice Address - Street 1:7310 PERSHING RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LYONS
Practice Address - State:IL
Practice Address - Zip Code:60534-1247
Practice Address - Country:US
Practice Address - Phone:708-447-9616
Practice Address - Fax:708-447-9626
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist