Provider Demographics
NPI:1558587493
Name:ABRAHAM, SARA (PT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ABRAHAM
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 1:1786 PAMPAS ST
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-2073
Mailing Address - Country:US
Mailing Address - Phone:630-248-4066
Mailing Address - Fax:
Practice Address - Street 1:520 E BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2181
Practice Address - Country:US
Practice Address - Phone:630-783-2438
Practice Address - Fax:630-739-2589
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist