Provider Demographics
NPI:1881999258
Name:BAEK, SARA E (PT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:BAEK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EUN JUNG
Other - Middle Name:
Other - Last Name:BAEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:36 ECKFORD ST APT 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4836
Mailing Address - Country:US
Mailing Address - Phone:347-561-0898
Mailing Address - Fax:
Practice Address - Street 1:36 ECKFORD ST APT 4A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4836
Practice Address - Country:US
Practice Address - Phone:347-561-0898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist