Provider Demographics
NPI:1477801116
Name:MARTINEZ, SARAH K (DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:K
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:K
Other - Last Name:STOVALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-3251
Practice Address - Street 1:1100 JOLIET ST
Practice Address - Street 2:SUITE 105
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1996
Practice Address - Country:US
Practice Address - Phone:219-864-3300
Practice Address - Fax:219-864-2567
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010760225100000X
IN05011117A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01429971OtherRR MEDICARE
GA1167873Medicare PIN