Provider Demographics
NPI:1306184817
Name:HOUSEL, SANDRA JOAN (LMT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JOAN
Last Name:HOUSEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14546-0102
Mailing Address - Country:US
Mailing Address - Phone:585-752-4500
Mailing Address - Fax:
Practice Address - Street 1:1687 ENGLISH RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-1692
Practice Address - Country:US
Practice Address - Phone:585-292-6428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018641172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist