Provider Demographics
NPI:1932745833
Name:SANDS, CHARLES ODELL (LPTA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ODELL
Last Name:SANDS
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 FATE RANKIN RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-3942
Mailing Address - Country:US
Mailing Address - Phone:865-282-6629
Mailing Address - Fax:
Practice Address - Street 1:914 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-4700
Practice Address - Country:US
Practice Address - Phone:865-397-3163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7263225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant