Provider Demographics
NPI:1669626305
Name:MUSIC, SANDRA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MUSIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39453 VAN DYKE AVE
Mailing Address - Street 2:APT 106
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-4656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3806 CLAYTON RD
Practice Address - Street 2:200
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-2516
Practice Address - Country:US
Practice Address - Phone:510-795-4294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012951225100000X
WAPT00010281225100000X
MA17978225100000X
VA2305205402225100000X
CO10064225100000X
CA35037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist