Provider Demographics
NPI:1932176799
Name:POWANDA, SANDRA (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:POWANDA
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 1:2555 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2135
Mailing Address - Country:US
Mailing Address - Phone:516-735-1018
Mailing Address - Fax:516-735-3882
Practice Address - Street 1:2555 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 1
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2135
Practice Address - Country:US
Practice Address - Phone:516-735-1018
Practice Address - Fax:516-735-3882
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024182-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ20R01Medicare ID - Type UnspecifiedPHYSICAL THERAPY