Provider Demographics
NPI:1740969039
Name:MOSS, SANDRA FLINT (PT)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:FLINT
Last Name:MOSS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:DARLENE
Other - Last Name:FLINT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6742 SUNNYBRAE AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-4055
Mailing Address - Country:US
Mailing Address - Phone:818-652-6982
Mailing Address - Fax:
Practice Address - Street 1:6742 SUNNYBRAE AVE
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-4055
Practice Address - Country:US
Practice Address - Phone:818-652-6982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty