Provider Demographics
NPI:1477710861
Name:GOE, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:WEGAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12581 MILSTEAD WAY
Mailing Address - Street 2:STE 201
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5446
Mailing Address - Country:US
Mailing Address - Phone:703-763-3922
Mailing Address - Fax:703-763-3927
Practice Address - Street 1:12581 MILSTEAD WAY
Practice Address - Street 2:STE 201
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5446
Practice Address - Country:US
Practice Address - Phone:703-763-3922
Practice Address - Fax:703-763-3927
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist