Provider Demographics
NPI:1548414691
Name:WULLER, SANDRA R (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:R
Last Name:WULLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:R
Other - Last Name:SCHRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9100 W 131ST TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-3096
Mailing Address - Country:US
Mailing Address - Phone:913-707-8362
Mailing Address - Fax:
Practice Address - Street 1:9100 W 131ST TER
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-3096
Practice Address - Country:US
Practice Address - Phone:913-707-8362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0984208100000X
KS11-01384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation