Provider Demographics
NPI:1972677185
Name:MOORE, SANDRA LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LYNN
Last Name:MOORE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:MORNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1005 G EASR ATLANTIC
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-6923
Mailing Address - Country:US
Mailing Address - Phone:814-942-3543
Mailing Address - Fax:
Practice Address - Street 1:429 MANOR DR
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4917
Practice Address - Country:US
Practice Address - Phone:814-471-2109
Practice Address - Fax:814-471-6902
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE007338225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant