Provider Demographics
NPI:1396918660
Name:DELIKAT, SARA M (PT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:DELIKAT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:KEYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:45551 MOUND RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48317-5100
Practice Address - Country:US
Practice Address - Phone:586-323-9224
Practice Address - Fax:586-323-9226
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN71490008Medicare PIN