Healthcare Provider Details

I. General information

NPI: 1316573728
Provider Name (Legal Business Name): SARAH E OBUCHOWSKI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N ROUTE 73 UNIT 80
WEST BERLIN NJ
08091-9202
US

IV. Provider business mailing address

614 N FORKLANDING RD
MAPLE SHADE NJ
08052-1006
US

V. Phone/Fax

Practice location:
  • Phone: 856-335-4938
  • Fax:
Mailing address:
  • Phone: 856-577-9323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01919000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: