Provider Demographics
NPI:1093731580
Name:SAU, SANDRA (RPT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:SAU
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:SAU-MARKOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:2796 SYCAMORE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1549
Mailing Address - Country:US
Mailing Address - Phone:805-520-3575
Mailing Address - Fax:805-520-3515
Practice Address - Street 1:2796 SYCAMORE DR STE 100
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1549
Practice Address - Country:US
Practice Address - Phone:805-520-3575
Practice Address - Fax:805-520-3515
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT22417Medicare ID - Type UnspecifiedPT LICENCE