Individual
SARAH ANN BOLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070016697
IL
225100000X
Physical Therapist
Primary
2019006629
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070016697
PHYSICAL THERAPY LICENSE
IL
01
—
2019006629
PHYSICAL THERAPY LICENSE
MO
Enumeration date
06/05/2019
Last updated
09/13/2021
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