Provider Demographics
NPI:1992178255
Name:SANDY, KATELYN ELIZABETH (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:KATELYN
Middle Name:ELIZABETH
Last Name:SANDY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 SACRAMENTO ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2383
Mailing Address - Country:US
Mailing Address - Phone:415-600-1431
Mailing Address - Fax:
Practice Address - Street 1:2324 SACRAMENTO ST
Practice Address - Street 2:SUITE 111
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2383
Practice Address - Country:US
Practice Address - Phone:415-600-1431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist