Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070020152 | IL |
NPI | 1003246372 |
---|---|
Provider Name | Sarah Goldenberg |
First Address | Highland Park, IL 60035-1916 |
Second Address | Oak Park, IL 60302-2519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2013 |
Last Update Date | 18/01/2014 |