Provider Demographics
NPI:1518230523
Name:SANDY, DANIEL ALAN (DPT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALAN
Last Name:SANDY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6444 MONROE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1454
Mailing Address - Country:US
Mailing Address - Phone:419-824-3434
Mailing Address - Fax:419-824-3435
Practice Address - Street 1:6444 MONROE ST
Practice Address - Street 2:SUITE B
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-1454
Practice Address - Country:US
Practice Address - Phone:419-824-3434
Practice Address - Fax:419-824-3435
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist