Provider Demographics
NPI:1821113457
Name:GILL, SANDRA (NCTMB)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 PEARL ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4366
Mailing Address - Country:US
Mailing Address - Phone:303-450-0726
Mailing Address - Fax:
Practice Address - Street 1:9101 PEARL ST
Practice Address - Street 2:SUITE 121
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4366
Practice Address - Country:US
Practice Address - Phone:303-450-0726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO145499-00 NCBTMB225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist