Provider Demographics
NPI:1780854315
Name:SARB, MICHELLE M (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:SARB
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:GARTELOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:850 43RD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8401
Mailing Address - Country:US
Mailing Address - Phone:309-743-2070
Mailing Address - Fax:309-743-2073
Practice Address - Street 1:850 43RD AVE STE 300
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-8401
Practice Address - Country:US
Practice Address - Phone:309-743-0900
Practice Address - Fax:309-743-0318
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-0116257225100000X
IA004219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA004219OtherIOWA PT LICENSE
IL070-016257OtherILLINOIS PT LICENSE NUMBE
IAI18344019Medicare Oscar/Certification
ILK50338Medicare PIN