Provider Demographics
NPI:1952169344
Name:ANDERSON, SANDRA GAYLE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:GAYLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-6454
Mailing Address - Country:US
Mailing Address - Phone:469-877-0994
Mailing Address - Fax:
Practice Address - Street 1:414 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-6454
Practice Address - Country:US
Practice Address - Phone:469-877-0994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT043172225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist