Provider Demographics
NPI:1770726614
Name:FOX, SANDRA LEE (DPT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:FOX
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:ALBRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:606 BLACK RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-3304
Mailing Address - Country:US
Mailing Address - Phone:843-651-1938
Mailing Address - Fax:
Practice Address - Street 1:606 BLACK RIVER RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-3304
Practice Address - Country:US
Practice Address - Phone:843-651-1938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist