Basic Information
| Provider Information | |||||||||
| NPI: | 1417956137 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WENGER | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | BROOK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT, OCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 409 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191473117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157628962 | ||||||||
| FaxNumber: | 2157623886 | ||||||||
| Practice Location | |||||||||
| Address1: | 245 N 15TH ST | ||||||||
| Address2: | MS 502 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191021101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157628962 | ||||||||
| FaxNumber: | 2157623886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 08/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT011284L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | DAPT000010 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251X0800X | PT011284L | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
ID Information
| ID | Type | State | Issuer | Description | 2327296000 | 01 | PA | IBC | OTHER | 2327296000 | 01 | PA | AMERIHEALTH | OTHER | 3694896 | 01 | PA | AETNA HMO | OTHER | 7855686 | 01 | PA | AETNA PPO | OTHER | 11361491 | 01 | PA | CAQH | OTHER | 1650465 | 01 | PA | HIGHMARK | OTHER |