Provider Demographics
NPI:1104038553
Name:GIESECKE, SANDRA L (PT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:GIESECKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:WALKER
Other - Last Name:GIESECKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:4175 CONWAY PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-7990
Mailing Address - Country:US
Mailing Address - Phone:407-850-0482
Mailing Address - Fax:
Practice Address - Street 1:8945 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-6918
Practice Address - Country:US
Practice Address - Phone:407-822-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist