Provider Demographics
NPI:1083025761
Name:SANDY SPA & WELLNESS
Entity Type:Organization
Organization Name:SANDY SPA & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:305-300-9633
Mailing Address - Street 1:2450 SW 137TH AVE STE 235
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6333
Mailing Address - Country:US
Mailing Address - Phone:305-300-9633
Mailing Address - Fax:
Practice Address - Street 1:2450 SW 137TH AVE STE 235
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6333
Practice Address - Country:US
Practice Address - Phone:305-300-9633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62693261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy