Provider Demographics
NPI:1821497249
Name:RANDALL, SARA L (DPT)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:L
Last Name:RANDALL
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 1:29D STONEHILL ROAD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543
Mailing Address - Country:US
Mailing Address - Phone:630-554-6156
Mailing Address - Fax:630-554-6378
Practice Address - Street 1:29D STONEHILL ROAD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543
Practice Address - Country:US
Practice Address - Phone:630-554-6156
Practice Address - Fax:630-554-6378
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.013618225100000X
IL070020869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist