Provider Demographics
NPI:1538463351
Name:HOUCK, SANDRA SUE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:SUE
Last Name:HOUCK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 HARBIN CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4304
Mailing Address - Country:US
Mailing Address - Phone:614-899-2708
Mailing Address - Fax:614-899-2708
Practice Address - Street 1:5412 HARBIN CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4304
Practice Address - Country:US
Practice Address - Phone:614-899-2708
Practice Address - Fax:614-899-2708
Is Sole Proprietor?:No
Enumeration Date:2011-01-08
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA 07786225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant