Provider Demographics
NPI:1790926749
Name:SPROULE, SANDRA JO (PT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JO
Last Name:SPROULE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:JO
Other - Last Name:SPROULE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:918 38TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-3158
Mailing Address - Country:US
Mailing Address - Phone:360-671-0471
Mailing Address - Fax:360-734-0225
Practice Address - Street 1:2905 CONNELLY AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-8225
Practice Address - Country:US
Practice Address - Phone:360-734-4181
Practice Address - Fax:360-734-0225
Is Sole Proprietor?:No
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000008972251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics