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NPI Code Detail

MEDICARE: SARAH CANCILLER MPT

MEDICARE: SARAH CANCILLER MPT
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 Therapist070015457IL

General Provider Information

NPI Number : 1497899025
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH CANCILLER MPT
Provider Business Mailing Address
First Line : 625 ENTERPRISE DR
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-8813
Country : US
Telephone Number : 630-575-6200
Fax Number : 630-928-5040
Provider Business Practice Location Address
First Line : 6255 S ARCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60638-2609
Country : US
Telephone Number : 773-284-6735
Fax Number : 773-284-6820
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2007
Last Update Date : 09/09/2016

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