Healthcare Provider Details

I. General information

NPI: 1114111564
Provider Name (Legal Business Name): SARAH ALEXIS HASBROUCK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 NEW BEDFORD RD
ROCHESTER MA
02770-4116
US

IV. Provider business mailing address

541 NEW BEDFORD RD
ROCHESTER MA
02770-4116
US

V. Phone/Fax

Practice location:
  • Phone: 631-965-7279
  • Fax:
Mailing address:
  • Phone: 631-965-7279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT02116
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: