Provider Demographics
NPI:1568708519
Name:NIEDERHOFFER, SARA R (PT)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:R
Last Name:NIEDERHOFFER
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 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:5300 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HTS
Practice Address - State:IL
Practice Address - Zip Code:62208-3500
Practice Address - Country:US
Practice Address - Phone:618-624-9300
Practice Address - Fax:618-624-9330
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012716225100000X
MO2016030535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist