MEDICARE: SARAH JO HAAG PT, DPT, WCS

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
1	225100000X	Physical Therapist	070014223	IL
2	2251X0800X	Orthopedic Physical Therapist	1146559	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1146559	OTHER	TX	PT LICENSE
2	070014223	OTHER	IL	PT LICENSE

General Provider Information

NPI Number	:	1295896447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH JO HAAG PT, DPT, WCS

Provider Business Mailing Address
First Line	:	2258 N FREMONT ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-3614
Country	:	US
Telephone Number	:	815-274-2073
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 N CLYBOURN AVE
Second Line	:	SUITE 302
City	:	CHICAGO
State	:	IL
Zip	:	60614-4946
Country	:	US
Telephone Number	:	773-747-4071
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	12/28/2012

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