Provider Demographics
NPI:1144415472
Name:WASKO, SANDRA J (MPT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:WASKO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 FIRST COLONIAL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3171
Mailing Address - Country:US
Mailing Address - Phone:757-817-5877
Mailing Address - Fax:757-412-1015
Practice Address - Street 1:968 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3171
Practice Address - Country:US
Practice Address - Phone:757-412-1005
Practice Address - Fax:757-412-1015
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA022290G72Medicare PIN