Provider Demographics
NPI:1336487917
Name:WILLIAMS, SARA RYAN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:RYAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:RYAN
Other - Last Name:KENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:14816 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BELOIT
Mailing Address - State:IL
Mailing Address - Zip Code:61080-2497
Mailing Address - Country:US
Mailing Address - Phone:815-520-7858
Mailing Address - Fax:
Practice Address - Street 1:550 S MULFORD RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2511
Practice Address - Country:US
Practice Address - Phone:815-229-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist