Individual
SARAH TEAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
631 FOXTAIL LN, SPRINGFIELD, IL 62707-8596
(217) 652-7780
Mailing address
631 FOXTAIL LN, SPRINGFIELD, IL 62707-8596
(217) 652-7780
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160006977
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160006977
DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
—
Enumeration date
10/30/2015
Last updated
10/30/2015
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