Provider Demographics
NPI:1205813235
Name:CARR, SANDY BROOKS (PT)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:BROOKS
Last Name:CARR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 GROVE RD
Mailing Address - Street 2:SUITE A2
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4660
Mailing Address - Country:US
Mailing Address - Phone:864-232-4908
Mailing Address - Fax:864-232-4728
Practice Address - Street 1:1011 GROVE RD
Practice Address - Street 2:SUITE A2
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4660
Practice Address - Country:US
Practice Address - Phone:864-232-4908
Practice Address - Fax:864-232-4728
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist