Provider Demographics
NPI:1043468192
Name:TRICOMI, SANDRA MARIE (PT)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MARIE
Last Name:TRICOMI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:MARIE
Other - Last Name:CHADWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1873 WESTERN AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203
Mailing Address - Country:US
Mailing Address - Phone:518-439-5006
Mailing Address - Fax:518-478-6474
Practice Address - Street 1:1873 WESTERN AVE
Practice Address - Street 2:STE 102
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-439-5006
Practice Address - Fax:518-478-6474
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist