MEDICARE: SARAH RYERSON PT

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	070-012952	IL

General Provider Information

NPI Number	:	1659358729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH RYERSON PT

Provider Business Mailing Address
First Line	:	625 ENTERPRISE DR
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-8813
Country	:	US
Telephone Number	:	630-575-1940
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 N RANDALL RD
Second Line	:
City	:	BATAVIA
State	:	IL
Zip	:	60510-1992
Country	:	US
Telephone Number	:	630-582-1512
Fax Number	:

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	09/19/2016

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Directions to “ SARAH RYERSON PT” Practice Location

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