Provider Demographics
NPI:1518230119
Name:WHITE SANDS PHYSICAL THERAPY AND AQUATICS, LLC
Entity Type:Organization
Organization Name:WHITE SANDS PHYSICAL THERAPY AND AQUATICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:504-908-9454
Mailing Address - Street 1:7147 CURTISS AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8012
Mailing Address - Country:US
Mailing Address - Phone:504-908-9454
Mailing Address - Fax:
Practice Address - Street 1:7147 CURTISS AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-8012
Practice Address - Country:US
Practice Address - Phone:504-908-9454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 22455261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy