Provider Demographics
NPI:1508002064
Name:PEBELSKE, SARAH JANE (DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE
Last Name:PEBELSKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4706
Mailing Address - Country:US
Mailing Address - Phone:773-284-9888
Mailing Address - Fax:773-284-9288
Practice Address - Street 1:6314 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4706
Practice Address - Country:US
Practice Address - Phone:773-284-9888
Practice Address - Fax:773-284-9288
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633794OtherBULE CROSS BLUE SHEILD OF ILLINOIS
IL208542Medicare PIN