Provider Demographics
NPI:1710333729
Name:SADOW, HILARY YOKO (PT)
Entity Type:Individual
Prefix:MISS
First Name:HILARY
Middle Name:YOKO
Last Name:SADOW
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 1:20 N 2ND ST
Mailing Address - Street 2:3
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2259
Mailing Address - Country:US
Mailing Address - Phone:269-687-9594
Mailing Address - Fax:269-687-9543
Practice Address - Street 1:20 N 2ND ST
Practice Address - Street 2:3
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2259
Practice Address - Country:US
Practice Address - Phone:269-687-9594
Practice Address - Fax:269-687-9543
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017497225100000X
IN05012013A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501017497OtherLICENSE NUMBER
IN05012013AOtherLICENSE NUMBER