Individual
SARA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1209 21ST AVE, ROCK ISLAND, IL 61201-7900
(309) 786-9334
Mailing address
7411 112TH ST, BLUE GRASS, IA 52726-9121
(563) 343-4735
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.004204
IL
Other
Enumeration date
12/13/2010
Last updated
12/13/2010
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