MEDICARE: MS. SARAH BROEG HAMMETT M.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070013637	IL

General Provider Information

NPI Number	:	1073835732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH BROEG HAMMETT M.P.T.

Provider Business Mailing Address
First Line	:	1635 W BELMONT AVE
Second Line	:	#702
City	:	CHICAGO
State	:	IL
Zip	:	60657-3047
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1635 W BELMONT AVE
Second Line	:	#702
City	:	CHICAGO
State	:	IL
Zip	:	60657-3047
Country	:	US
Telephone Number	:	773-621-0779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2010
Last Update Date	:	02/23/2010

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