Provider Demographics
NPI:1851403356
Name:SANBORN, JOANNE M (PT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:M
Last Name:SANBORN
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 1:38 ROCKLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-1568
Mailing Address - Country:US
Mailing Address - Phone:860-644-7675
Mailing Address - Fax:
Practice Address - Street 1:1 HAMILTON RD
Practice Address - Street 2:MEDICAL DEPARTMENT, MS 1-1-BC38
Practice Address - City:WINDSOR LOCKS
Practice Address - State:CT
Practice Address - Zip Code:06096-1000
Practice Address - Country:US
Practice Address - Phone:860-654-2503
Practice Address - Fax:860-654-5816
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist