Provider Demographics
NPI:1710389861
Name:CHASE, SANDRA ANN (LMT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:CHASE
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 1:717 TURNERWOODS RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-3549
Mailing Address - Country:US
Mailing Address - Phone:478-972-8306
Mailing Address - Fax:
Practice Address - Street 1:111 ATLANTA RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-5541
Practice Address - Country:US
Practice Address - Phone:478-972-8306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT003469225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist