Provider Demographics
NPI:1184982738
Name:STURDIVANT, SANDI KAY (PTA)
Entity type:Individual
Prefix:MRS
First Name:SANDI
Middle Name:KAY
Last Name:STURDIVANT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:SANDI
Other - Middle Name:KAY
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2440
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71914-2440
Mailing Address - Country:US
Mailing Address - Phone:501-624-6468
Mailing Address - Fax:501-624-1075
Practice Address - Street 1:407 CARSON ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS NATIONAL PARK
Practice Address - State:AR
Practice Address - Zip Code:71901-6852
Practice Address - Country:US
Practice Address - Phone:501-624-6468
Practice Address - Fax:501-624-1075
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1792225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant