MEDICARE: SARAH MERRILL

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	9902-24	WI

General Provider Information

NPI Number	:	1215182530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH MERRILL

Provider Business Mailing Address
First Line	:	5755 S VISTA CT
Second Line	:
City	:	NEW BERLIN
State	:	WI
Zip	:	53146-5037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5755 S VISTA CT
Second Line	:
City	:	NEW BERLIN
State	:	WI
Zip	:	53146-5037
Country	:	US
Telephone Number	:	262-682-4613
Fax Number	:

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

Provider Enumeration Date	:	12/01/2008
Last Update Date	:	12/01/2008

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Directions to “ SARAH MERRILL ” Practice Location

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