Provider Demographics
NPI:1407814437
Name:KONOPASEK, SARAH MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MARIE
Last Name:KONOPASEK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8047 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-1349
Mailing Address - Country:US
Mailing Address - Phone:219-688-9633
Mailing Address - Fax:219-662-7814
Practice Address - Street 1:11360 BROADWAY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7104
Practice Address - Country:US
Practice Address - Phone:219-662-8929
Practice Address - Fax:219-662-7814
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007873A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist