Provider Demographics
NPI:1750413688
Name:BEERNTSEN, SARAH E (DPT)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:E
Last Name:BEERNTSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S. GREEN BAY RD #205
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406
Mailing Address - Country:US
Mailing Address - Phone:262-898-3930
Mailing Address - Fax:262-898-3933
Practice Address - Street 1:1300 S GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4469
Practice Address - Country:US
Practice Address - Phone:262-321-0240
Practice Address - Fax:262-321-0242
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006017287225100000X
WI10978-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO37027014OtherBSBS PROVIDER NUMBER
MO578907909Medicaid
MO431742269OtherTAX ID NUMBER
MO431742269OtherTAX ID NUMBER