Provider Demographics
NPI:1922125905
Name:SAND, NEAL FREDERICK (ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:NEAL
Middle Name:FREDERICK
Last Name:SAND
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-3872
Mailing Address - Country:US
Mailing Address - Phone:802-893-6724
Mailing Address - Fax:
Practice Address - Street 1:140 PATRICK GYM
Practice Address - Street 2:SPEAR STREET
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05405-0001
Practice Address - Country:US
Practice Address - Phone:802-656-9573
Practice Address - Fax:802-656-9578
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT10400000682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer