Provider Demographics
NPI:1346664729
Name:SAND, PETER (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:SAND
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 WESTOWN PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-7702
Mailing Address - Country:US
Mailing Address - Phone:515-224-5225
Mailing Address - Fax:515-224-5235
Practice Address - Street 1:1850 SUNSET DR STE 102
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:IA
Practice Address - Zip Code:50211-1365
Practice Address - Country:US
Practice Address - Phone:515-539-1310
Practice Address - Fax:515-953-1322
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0006302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer