Provider Demographics
NPI:1932109147
Name:DIAL-CRUSE, SANDRA WADDELL (RMT, RFM, CLT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:WADDELL
Last Name:DIAL-CRUSE
Suffix:
Gender:F
Credentials:RMT, RFM, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 BRIAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7336
Mailing Address - Country:US
Mailing Address - Phone:409-892-1969
Mailing Address - Fax:409-924-0044
Practice Address - Street 1:5695 EASTEX FWY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6923
Practice Address - Country:US
Practice Address - Phone:409-924-9222
Practice Address - Fax:409-924-0044
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist