Provider Demographics
NPI:1477888584
Name:SMITH, SANDRA MYER (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MYER
Last Name:SMITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:YVONNE
Other - Last Name:MYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 APRICOT AVE
Mailing Address - Street 2:
Mailing Address - City:LEOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17540-2200
Mailing Address - Country:US
Mailing Address - Phone:717-572-9447
Mailing Address - Fax:
Practice Address - Street 1:1380 ELM AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4642
Practice Address - Country:US
Practice Address - Phone:717-391-6430
Practice Address - Fax:717-399-8152
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000149L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant