Provider Demographics
NPI:1073697769
Name:POMEROY, SANDRA J (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:POMEROY
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 1:3839 STATE ROUTE 123
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-9433
Mailing Address - Country:US
Mailing Address - Phone:440-777-6017
Mailing Address - Fax:440-777-6940
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:STE 6254
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-4834
Practice Address - Fax:937-208-6201
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.001681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPO0816171Medicare ID - Type Unspecified