Provider Demographics
NPI:1457860496
Name:SHIRLEY, SANDRA M (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 W 24TH PL
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-1810
Mailing Address - Country:US
Mailing Address - Phone:541-852-7882
Mailing Address - Fax:
Practice Address - Street 1:95 DIVISION AVE STE A
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-5428
Practice Address - Country:US
Practice Address - Phone:541-852-7882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR01714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist