Provider Demographics
NPI:1255595542
Name:PICKERING, SANDRA KAY (PTA)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:KAY
Last Name:PICKERING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W GREEN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1014
Mailing Address - Country:US
Mailing Address - Phone:765-462-3311
Mailing Address - Fax:
Practice Address - Street 1:200 W GREEN MEADOWS DR
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1014
Practice Address - Country:US
Practice Address - Phone:765-462-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99032549A225200000X, 320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities