Provider Demographics
NPI:1669140042
Name:JUNG, SARA LOUISE (MPT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LOUISE
Last Name:JUNG
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 MARSH DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-9120
Mailing Address - Country:US
Mailing Address - Phone:513-886-6806
Mailing Address - Fax:
Practice Address - Street 1:4000 EXECUTIVE PARK DR STE 225
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-4009
Practice Address - Country:US
Practice Address - Phone:513-297-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist