Provider Demographics
NPI:1952728628
Name:RAFFETY, SANDRA L (LMT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:RAFFETY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:KOCHIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:315 N RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132-1617
Mailing Address - Country:US
Mailing Address - Phone:386-427-8403
Mailing Address - Fax:386-427-8410
Practice Address - Street 1:315 N RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-1617
Practice Address - Country:US
Practice Address - Phone:386-427-8403
Practice Address - Fax:386-427-8410
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46642225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist