Provider Demographics
NPI:1801040191
Name:POWELL, SANDRA LOUISE (CMT)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LOUISE
Last Name:POWELL
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 BLAINE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-3731
Mailing Address - Country:US
Mailing Address - Phone:208-283-6070
Mailing Address - Fax:
Practice Address - Street 1:704 BLAINE ST STE 3
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-3731
Practice Address - Country:US
Practice Address - Phone:208-283-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist