Provider Demographics
NPI:1578650487
Name:ORESKO, SARAH A (PT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:ORESKO
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 1:3028 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2640
Mailing Address - Country:US
Mailing Address - Phone:219-477-6888
Mailing Address - Fax:219-477-6804
Practice Address - Street 1:3028 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2640
Practice Address - Country:US
Practice Address - Phone:219-477-6888
Practice Address - Fax:219-477-6804
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001631A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200936050Medicaid
IN000000179153OtherBCBS
IN05001631AOtherLICENSE
IN000000609142OtherBC/BS
IN091110BMedicare ID - Type Unspecified
IN650020337Medicare ID - Type UnspecifiedRR MC