Provider Demographics
NPI:1114153251
Name:DISANDRO, JOSEPH JOHN (PTA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:JOHN
Last Name:DISANDRO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 O'NEAL LANE BLDG C, STE D
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3179
Mailing Address - Country:US
Mailing Address - Phone:225-751-3696
Mailing Address - Fax:225-751-3697
Practice Address - Street 1:2645 O'NEAL LANE BLDG C, STE D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3179
Practice Address - Country:US
Practice Address - Phone:225-751-3696
Practice Address - Fax:225-751-3697
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant