Provider Demographics
NPI:1639131451
Name:HEBERLEIN, SARA MOCKERT (PT)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MOCKERT
Last Name:HEBERLEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LYNN
Other - Last Name:MOCKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-2535
Mailing Address - Country:US
Mailing Address - Phone:262-695-6744
Mailing Address - Fax:262-695-6466
Practice Address - Street 1:1300 CAPITOL DR
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-2535
Practice Address - Country:US
Practice Address - Phone:262-695-6744
Practice Address - Fax:262-695-6466
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6146-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40439500Medicaid
WI0023Medicare ID - Type Unspecified
WIS84031Medicare UPIN
WI81030Medicare PIN