Provider Demographics
NPI:1447684113
Name:GREENHAGEN, SARAH (DPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GREENHAGEN
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 1:710 E RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-2250
Mailing Address - Country:US
Mailing Address - Phone:815-313-6333
Mailing Address - Fax:815-417-6921
Practice Address - Street 1:710 E RAILROAD ST
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548
Practice Address - Country:US
Practice Address - Phone:815-313-6333
Practice Address - Fax:815-417-6921
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020085174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist