Provider Demographics
NPI:1497128524
Name:RODRIGUEZ, SARA R (LMT)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:R
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2713
Mailing Address - Country:US
Mailing Address - Phone:312-479-1885
Mailing Address - Fax:
Practice Address - Street 1:806 W WASHINGTON BLVD
Practice Address - Street 2:SUITE 203 B-D
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2338
Practice Address - Country:US
Practice Address - Phone:312-650-9798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.016879208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation