Provider Demographics
NPI:1417956137
Name:WENGER, SARAH BROOK (PT, DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:BROOK
Last Name:WENGER
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3117
Mailing Address - Country:US
Mailing Address - Phone:215-762-8962
Mailing Address - Fax:215-762-3886
Practice Address - Street 1:245 N 15TH ST
Practice Address - Street 2:MS 502
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1101
Practice Address - Country:US
Practice Address - Phone:215-762-8962
Practice Address - Fax:215-762-3886
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011284L225100000X, 2251X0800X
PADAPT000010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2327296000OtherIBC
PA2327296000OtherAMERIHEALTH
PA3694896OtherAETNA HMO
PA7855686OtherAETNA PPO
PA11361491OtherCAQH
PA1650465OtherHIGHMARK
PA7855686OtherAETNA PPO