Healthcare Provider Details

I. General information

NPI: 1114408473
Provider Name (Legal Business Name): SARAH LORRAINE FYOCK PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 W 13TH ST
WILMINGTON DE
19806-4009
US

IV. Provider business mailing address

1713 W 13TH ST
WILMINGTON DE
19806-4009
US

V. Phone/Fax

Practice location:
  • Phone: 724-812-2013
  • Fax:
Mailing address:
  • Phone: 724-812-2013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070023763
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0004229
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: