Provider Demographics
NPI:1033754593
Name:SANDY, CHRISSY
Entity Type:Individual
Prefix:
First Name:CHRISSY
Middle Name:
Last Name:SANDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISSY
Other - Middle Name:
Other - Last Name:RUNK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:WV
Mailing Address - Zip Code:26210-0103
Mailing Address - Country:US
Mailing Address - Phone:304-516-9481
Mailing Address - Fax:
Practice Address - Street 1:1 MARKET SQUARE PLAZA
Practice Address - Street 2:
Practice Address - City:BUCIKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201
Practice Address - Country:US
Practice Address - Phone:304-516-9481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty