Provider Demographics
NPI:1285679746
Name:WHALEY, SANDRA DAVIS (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:DAVIS
Last Name:WHALEY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 SAINT LUKES DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7105
Mailing Address - Country:US
Mailing Address - Phone:334-244-5892
Mailing Address - Fax:334-244-5890
Practice Address - Street 1:499 SAINT LUKES DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7105
Practice Address - Country:US
Practice Address - Phone:334-244-5892
Practice Address - Fax:334-244-5890
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051529898Medicare ID - Type Unspecified