Provider Demographics
NPI:1609308394
Name:ILLIG, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ILLIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 MANOR RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-5702
Mailing Address - Country:US
Mailing Address - Phone:512-457-0575
Mailing Address - Fax:
Practice Address - Street 1:3110 MANOR RD
Practice Address - Street 2:SUITE F
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-5702
Practice Address - Country:US
Practice Address - Phone:512-457-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM11673225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist