MEDICARE: DR. SARAH BROOK WENGER PT, DPT, OCS

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	PT011284L	PA
2	225100000X	Physical Therapist	DAPT000010	PA
3	2251X0800X	Orthopedic Physical Therapist	PT011284L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2327296000	OTHER	PA	IBC
2	2327296000	OTHER	PA	AMERIHEALTH
3	3694896	OTHER	PA	AETNA HMO
4	7855686	OTHER	PA	AETNA PPO
5	11361491	OTHER	PA	CAQH
6	1650465	OTHER	PA	HIGHMARK

General Provider Information

NPI Number	:	1417956137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH BROOK WENGER PT, DPT, OCS

Provider Business Mailing Address
First Line	:	409 MONROE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-3117
Country	:	US
Telephone Number	:	215-762-8962
Fax Number	:	215-762-3886

Provider Business Practice Location Address
First Line	:	245 N 15TH ST
Second Line	:	MS 502
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1101
Country	:	US
Telephone Number	:	215-762-8962
Fax Number	:	215-762-3886

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	08/27/2013

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Directions to “ DR. SARAH BROOK WENGER PT, DPT, OCS” Practice Location

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