Provider Demographics
NPI:1710955687
Name:KLASSEN, SANDRA LEE (MS PT AT C)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LEE
Last Name:KLASSEN
Suffix:
Gender:F
Credentials:MS PT AT C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26201 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134
Mailing Address - Country:US
Mailing Address - Phone:239-498-0558
Mailing Address - Fax:239-498-0557
Practice Address - Street 1:26201 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134
Practice Address - Country:US
Practice Address - Phone:239-498-0558
Practice Address - Fax:239-498-0557
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885209000Medicaid
FLY905QOtherBCBS
FL650009083OtherTRICARE
FL885209000Medicaid