Provider Demographics
NPI:1891061107
Name:VANHORN, SANDRA J (LMT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:VANHORN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:VAN HORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:9974 BOCA GARDENS TRL APT D
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3729
Mailing Address - Country:US
Mailing Address - Phone:561-929-4316
Mailing Address - Fax:
Practice Address - Street 1:9974 BOCA GARDENS TRL APT D
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-3729
Practice Address - Country:US
Practice Address - Phone:561-929-4316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA53938225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist