Provider Demographics
NPI:1013128578
Name:SANDOVAL, DANNY E (LMT)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:E
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 MOLLIE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-2946
Mailing Address - Country:US
Mailing Address - Phone:516-984-1059
Mailing Address - Fax:631-588-0911
Practice Address - Street 1:511 MOLLIE BLVD
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-2946
Practice Address - Country:US
Practice Address - Phone:516-984-1059
Practice Address - Fax:631-588-0911
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009301172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist