Provider Demographics
NPI:1649633405
Name:ORDONIO-SASAURA, MARGIE (PT)
Entity type:Individual
Prefix:
First Name:MARGIE
Middle Name:
Last Name:ORDONIO-SASAURA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 WOODGROVE WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4024
Mailing Address - Country:US
Mailing Address - Phone:916-797-1013
Mailing Address - Fax:
Practice Address - Street 1:1540 WOODGROVE WAY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4024
Practice Address - Country:US
Practice Address - Phone:916-797-1013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist