Provider Demographics
NPI:1073604005
Name:HUGGARD, SANDRA (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:HUGGARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N DIXIE FWY
Mailing Address - Street 2:STE 916
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-6220
Mailing Address - Country:US
Mailing Address - Phone:386-314-3409
Mailing Address - Fax:866-239-9013
Practice Address - Street 1:900 N DIXIE FWY
Practice Address - Street 2:STE 916
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-6220
Practice Address - Country:US
Practice Address - Phone:386-314-3409
Practice Address - Fax:866-239-9013
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889121400Medicaid
FLY7942ZMedicare PIN