Provider Demographics
NPI:1790296929
Name:KHOURY, SARAH M (DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:KHOURY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 N EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4868
Mailing Address - Country:US
Mailing Address - Phone:309-839-8631
Mailing Address - Fax:855-579-3536
Practice Address - Street 1:5101 N EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4868
Practice Address - Country:US
Practice Address - Phone:309-839-8631
Practice Address - Fax:855-579-3536
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist