Provider Demographics
NPI:1205363272
Name:FLANSBURG, SANDRA MARIE (MT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:FLANSBURG
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2514
Mailing Address - Country:US
Mailing Address - Phone:303-775-8115
Mailing Address - Fax:
Practice Address - Street 1:351 COFFMAN ST STE 120
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5457
Practice Address - Country:US
Practice Address - Phone:303-835-7882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-21
Last Update Date:2017-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013791225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty