Provider Demographics
NPI:1295896447
Name:HAAG, SARAH JO (PT, DPT, WCS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JO
Last Name:HAAG
Suffix:
Gender:F
Credentials:PT, DPT, WCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2258 N FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3614
Mailing Address - Country:US
Mailing Address - Phone:815-274-2073
Mailing Address - Fax:
Practice Address - Street 1:1925 N CLYBOURN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4946
Practice Address - Country:US
Practice Address - Phone:773-747-4071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014223225100000X
TX11465592251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1146559OtherPT LICENSE
IL070014223OtherPT LICENSE