Provider Demographics
NPI:1659588028
Name:FELTE, SANDRA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:FELTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 WILD RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2584
Mailing Address - Country:US
Mailing Address - Phone:303-530-0442
Mailing Address - Fax:
Practice Address - Street 1:311 MAPLETONE AVE.
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-9130
Practice Address - Country:US
Practice Address - Phone:303-441-0526
Practice Address - Fax:303-441-2215
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1062174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist