Provider Demographics
NPI:1093136772
Name:ECCLESTONE, SANDI (MS, PT)
Entity Type:Individual
Prefix:MRS
First Name:SANDI
Middle Name:
Last Name:ECCLESTONE
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 OLD ALABAMA RD
Mailing Address - Street 2:BUILDING E
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8594
Mailing Address - Country:US
Mailing Address - Phone:770-552-8852
Mailing Address - Fax:770-552-8481
Practice Address - Street 1:3005 OLD ALABAMA RD
Practice Address - Street 2:BUILDING E
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8594
Practice Address - Country:US
Practice Address - Phone:770-552-8852
Practice Address - Fax:770-552-8481
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist