Provider Demographics
NPI:1376805861
Name:SABOL, MICHAEL ANTHONY (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:SABOL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:37464 LION DR
Practice Address - Street 2:UNIT 4
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975
Practice Address - Country:US
Practice Address - Phone:302-988-1586
Practice Address - Fax:302-988-1593
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003035225100000X
PAPT022260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA245411VKFMedicare PIN