Provider Demographics
NPI:1194032136
Name:SPROLE, SANDRA MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARIE
Last Name:SPROLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:MARIE
Other - Last Name:MANIKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1801 GRAND ISLAND BLVD
Mailing Address - Street 2:FREEDOM PLACE
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2171
Mailing Address - Country:US
Mailing Address - Phone:716-773-4323
Mailing Address - Fax:716-773-9418
Practice Address - Street 1:1801 GRAND ISLAND BLVD
Practice Address - Street 2:FREEDOM PLACE
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-2171
Practice Address - Country:US
Practice Address - Phone:716-773-4323
Practice Address - Fax:716-773-9418
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0009669-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist