Provider Demographics
NPI:1982738050
Name:HILGEDIECK, SARA J (PT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:HILGEDIECK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:J
Other - Last Name:NOVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:13 EXECUTIVE DRIVE
Mailing Address - Street 2:STE.18
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208
Mailing Address - Country:US
Mailing Address - Phone:618-624-8105
Mailing Address - Fax:618-624-8214
Practice Address - Street 1:13 EXECUTIVE DRIVE
Practice Address - Street 2:STE. 18
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208
Practice Address - Country:US
Practice Address - Phone:618-624-8105
Practice Address - Fax:618-624-8214
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist