Provider Demographics
NPI:1023200664
Name:ATKINSON, SANDRA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3004
Mailing Address - Country:US
Mailing Address - Phone:850-586-0444
Mailing Address - Fax:
Practice Address - Street 1:446 RACETRACK RD NW
Practice Address - Street 2:UNIT C
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-3860
Practice Address - Country:US
Practice Address - Phone:850-586-0444
Practice Address - Fax:850-863-5329
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43771225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC3998OtherBC/BS