Provider Demographics
NPI:1730308628
Name:HAUCK, SANDRA LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LYNN
Last Name:HAUCK
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 1:1002 S DILLARD ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3991
Mailing Address - Country:US
Mailing Address - Phone:407-905-8908
Mailing Address - Fax:407-905-8908
Practice Address - Street 1:9740 WYLAND CT
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-5610
Practice Address - Country:US
Practice Address - Phone:407-876-0044
Practice Address - Fax:407-905-8908
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 19258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist