Healthcare Provider Details

I. General information

NPI: 1316386105
Provider Name (Legal Business Name): SARAH MARGARET CARDY GONCALVES PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH MARGARET CARDY

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2672 S. ROCHESTER RD.
ROCHESTER HILLS MI
48307
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 248-534-0930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number5501015627
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: