Provider Demographics
NPI:1942313549
Name:USTARIS, SANDRA
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:
Last Name:USTARIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:USTARIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2129 W OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4131
Mailing Address - Country:US
Mailing Address - Phone:215-336-6630
Mailing Address - Fax:215-336-3928
Practice Address - Street 1:2129 W OREGON AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19145-4131
Practice Address - Country:US
Practice Address - Phone:215-336-6630
Practice Address - Fax:215-336-3928
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT 017952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist