Provider Demographics
NPI:1477052744
Name:GERSBACH, SANDRA JEANNE (LMT, RN)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JEANNE
Last Name:GERSBACH
Suffix:
Gender:F
Credentials:LMT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SW INDUSTRIAL WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1011
Mailing Address - Country:US
Mailing Address - Phone:541-728-3911
Mailing Address - Fax:
Practice Address - Street 1:550 SW INDUSTRIAL WAY STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1011
Practice Address - Country:US
Practice Address - Phone:541-728-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLMT-023459225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty