Provider Demographics
NPI:1205134798
Name:GOODRICH, SANDRA SAUER (PT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:SAUER
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:ANNE
Other - Last Name:SAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:27 HARWICK DR
Mailing Address - Street 2:
Mailing Address - City:GLENMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12077-3110
Mailing Address - Country:US
Mailing Address - Phone:518-478-9023
Mailing Address - Fax:518-478-9023
Practice Address - Street 1:27 HARWICK DR
Practice Address - Street 2:
Practice Address - City:GLENMONT
Practice Address - State:NY
Practice Address - Zip Code:12077-3110
Practice Address - Country:US
Practice Address - Phone:518-478-9023
Practice Address - Fax:518-478-9023
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist