Provider Demographics
NPI:1639612609
Name:HEIM, SARA L (DPT)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:L
Last Name:HEIM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:L
Other - Last Name:DYCKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:405 GETTYSBURG DRIVE
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978
Mailing Address - Country:US
Mailing Address - Phone:631-514-5571
Mailing Address - Fax:631-325-2941
Practice Address - Street 1:405 GETTYSBURG DRIVE
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978
Practice Address - Country:US
Practice Address - Phone:631-514-5571
Practice Address - Fax:631-325-2941
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist