Provider Demographics
NPI:1235500414
Name:SANDRY, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SANDRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 WINSTON DR
Mailing Address - Street 2:APT 2
Mailing Address - City:EDGERTON
Mailing Address - State:WI
Mailing Address - Zip Code:53534-1034
Mailing Address - Country:US
Mailing Address - Phone:608-214-0431
Mailing Address - Fax:
Practice Address - Street 1:4502 MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-2133
Practice Address - Country:US
Practice Address - Phone:608-249-2137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2370-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant