Provider Demographics
NPI:1689073900
Name:WIEDERIN, SARA KRISTIN (DPT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:KRISTIN
Last Name:WIEDERIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:K
Other - Last Name:DALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-7555
Mailing Address - Fax:515-643-7560
Practice Address - Street 1:800 E 1ST ST STE 2000
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2077
Practice Address - Country:US
Practice Address - Phone:515-643-7555
Practice Address - Fax:515-643-7560
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist