Provider Demographics
NPI:1295709301
Name:DEMEIS, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:DEMEIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SUNAPEE ST
Mailing Address - Street 2:UNIT ONE
Mailing Address - City:NEWPORT
Mailing Address - State:NH
Mailing Address - Zip Code:03773-5412
Mailing Address - Country:US
Mailing Address - Phone:603-863-3260
Mailing Address - Fax:603-863-3291
Practice Address - Street 1:23 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773-1504
Practice Address - Country:US
Practice Address - Phone:603-863-3260
Practice Address - Fax:603-863-3291
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0805563Y0NH01OtherANTHEM
NH30010225Medicaid
NH30010225Medicaid