Provider Demographics
NPI:1780938126
Name:DALLES, SANDRA (PTA, ATC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:DALLES
Suffix:
Gender:F
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:KROOHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:4686 E ASBURY CIR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4723
Mailing Address - Country:US
Mailing Address - Phone:303-300-8865
Mailing Address - Fax:
Practice Address - Street 1:4686 E ASBURY CIR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4723
Practice Address - Country:US
Practice Address - Phone:303-300-8865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012953225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant