Provider Demographics
NPI:1629150305
Name:EISENMANN, SANDRA CATHERINE (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:CATHERINE
Last Name:EISENMANN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:CATHERINE
Other - Last Name:RIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1200 W JEFFERSON ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-3694
Mailing Address - Country:US
Mailing Address - Phone:217-726-8502
Mailing Address - Fax:
Practice Address - Street 1:1200 W JEFFERSON ST
Practice Address - Street 2:SUITE D
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-3694
Practice Address - Country:US
Practice Address - Phone:217-726-8502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70007939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist