Provider Demographics
NPI:1679896518
Name:CARNEY, SANDRA L (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:CARNEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 S CHASE ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-6581
Mailing Address - Country:US
Mailing Address - Phone:630-808-9630
Mailing Address - Fax:
Practice Address - Street 1:810 S CHASE ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-6581
Practice Address - Country:US
Practice Address - Phone:630-808-9630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-07
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227007805225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist