Provider Demographics
NPI:1285617266
Name:DISIBIO, SABRINA (MSPT)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:DISIBIO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:
Other - Last Name:HARDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:4102 OGLETOWN STANTON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4169
Practice Address - Country:US
Practice Address - Phone:302-894-1800
Practice Address - Fax:302-894-1811
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017730225100000X
DEJ10002026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
221629692OtherCHAMPUS
DE1285617266Medicaid
11523734OtherCAQH
280697000OtherIBC AMERIHEALTH
DE1285617266Medicaid