Healthcare Provider Details

I. General information

NPI: 1073474433
Provider Name (Legal Business Name): SARAH N HARTZOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 BRICKYARD DR APT J5
BLOOMINGTON IL
61701-7516
US

IV. Provider business mailing address

20 BRICKYARD DR APT J5
BLOOMINGTON IL
61701-7516
US

V. Phone/Fax

Practice location:
  • Phone: 309-202-6308
  • Fax:
Mailing address:
  • Phone:
  • Fax: 159-964-6920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.009016
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: