Provider Demographics
NPI:1023160629
Name:NICOLARSEN, SARAH MARIE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MARIE
Last Name:NICOLARSEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 S. KIMBARK AVE.
Mailing Address - Street 2:#3W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-3752
Mailing Address - Country:US
Mailing Address - Phone:773-484-0427
Mailing Address - Fax:
Practice Address - Street 1:5121 S KIMBARK AVE
Practice Address - Street 2:#3W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-3988
Practice Address - Country:US
Practice Address - Phone:773-484-0427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0146572251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics