Provider Demographics
NPI:1861778524
Name:NECHVATAL, SARAH BETH (DPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:NECHVATAL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 N EDGE TRL
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1948
Mailing Address - Country:US
Mailing Address - Phone:319-431-4700
Mailing Address - Fax:
Practice Address - Street 1:202 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1507
Practice Address - Country:US
Practice Address - Phone:319-431-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2023-02-01
Deactivation Date:2022-02-21
Deactivation Code:
Reactivation Date:2022-03-07
Provider Licenses
StateLicense IDTaxonomies
WI10779-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist