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NPI Code Detail

MEDICARE: SARAH A WEGNER PT

MEDICARE: SARAH A WEGNER PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist11737-24WI

General Provider Information

NPI Number : 1184919359
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH A WEGNER PT
Provider Business Mailing Address
First Line : PO BOX 19070
Second Line :
City : GREEN BAY
State : WI
Zip : 54307-9070
Country : US
Telephone Number : 920-496-4700
Fax Number :
Provider Business Practice Location Address
First Line : 825 WALTON DR
Second Line :
City : PLYMOUTH
State : WI
Zip : 53073-5022
Country : US
Telephone Number : 920-892-4322
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2011
Last Update Date : 09/27/2016

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