Provider Demographics
NPI:1821579186
Name:SUDDES, SARAH KATHERINE (DPT, PT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHERINE
Last Name:SUDDES
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:KATHERINE
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:5629 PLANK RD STE 107
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-7216
Practice Address - Country:US
Practice Address - Phone:540-445-0206
Practice Address - Fax:540-739-7473
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19171225100000X
VA2305216319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist