Provider Demographics
NPI:1780637397
Name:DO, SANDRA ANN (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:DO
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 1:12001 W 63RD PL
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-4034
Mailing Address - Country:US
Mailing Address - Phone:303-456-2671
Mailing Address - Fax:303-456-0220
Practice Address - Street 1:12001 W 63RD PL
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-4034
Practice Address - Country:US
Practice Address - Phone:303-456-2671
Practice Address - Fax:303-456-0220
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC476258Medicare PIN