Provider Demographics
NPI:1073749719
Name:HEPP, SANDRA LEE (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:HEPP
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 1:4330 CEDAR LAKE RD S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3700
Mailing Address - Country:US
Mailing Address - Phone:952-381-3434
Mailing Address - Fax:952-377-1430
Practice Address - Street 1:4330 CEDAR LAKE RD S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3700
Practice Address - Country:US
Practice Address - Phone:952-381-3434
Practice Address - Fax:952-377-1430
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN774OtherPHYSICAL THERAPY LICENSE