Provider Demographics
NPI:1386683365
Name:SANDAL, JUSTIN W (PT)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:W
Last Name:SANDAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-6725
Mailing Address - Country:US
Mailing Address - Phone:334-826-2090
Mailing Address - Fax:334-821-3191
Practice Address - Street 1:161 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-6725
Practice Address - Country:US
Practice Address - Phone:334-826-2090
Practice Address - Fax:334-821-3191
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ16696Medicare UPIN