Provider Demographics
NPI:1831358019
Name:VANDERBLOOMER, SARA J (PT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:VANDERBLOOMER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 N DELANY RD
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2007
Mailing Address - Country:US
Mailing Address - Phone:847-244-7070
Mailing Address - Fax:847-224-7071
Practice Address - Street 1:1125 N DELANY RD
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2007
Practice Address - Country:US
Practice Address - Phone:847-244-7070
Practice Address - Fax:847-244-7071
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.014838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist