Healthcare Provider Details

I. General information

NPI: 1417956137
Provider Name (Legal Business Name): SARAH BROOK WENGER PT, DPT, OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N 15TH ST MS 502
PHILADELPHIA PA
19102-1101
US

IV. Provider business mailing address

409 MONROE ST
PHILADELPHIA PA
19147-3117
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-8962
  • Fax: 215-762-3886
Mailing address:
  • Phone: 215-762-8962
  • Fax: 215-762-3886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT011284L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberDAPT000010
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT011284L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: