Provider Demographics
NPI:1609434448
Name:BOLAND, SARAH ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:BOLAND
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANN
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2638 MANOR HILL DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-6350
Mailing Address - Country:US
Mailing Address - Phone:217-430-7556
Mailing Address - Fax:
Practice Address - Street 1:507 HUCK FINN SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-2295
Practice Address - Country:US
Practice Address - Phone:573-248-1350
Practice Address - Fax:573-248-1649
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016697225100000X
MO2019006629225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070016697OtherPHYSICAL THERAPY LICENSE
MO2019006629OtherPHYSICAL THERAPY LICENSE