Provider Demographics
NPI:1700522588
Name:HARTL, SARA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HARTL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7930 HARWOOD AVE APT 308
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2570
Mailing Address - Country:US
Mailing Address - Phone:262-902-3057
Mailing Address - Fax:
Practice Address - Street 1:230 N WALWORTH AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:WILLIAMS BAY
Practice Address - State:WI
Practice Address - Zip Code:53191-9202
Practice Address - Country:US
Practice Address - Phone:262-607-6677
Practice Address - Fax:262-474-3719
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15642-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist