Basic Information
| Provider Information | |||||||||
| NPI: | 1790926749 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPROULE | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SPROULE | ||||||||
| OtherFirstName: | SANDRA | ||||||||
| OtherMiddleName: | JO | ||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 918 38TH ST | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982293158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606710471 | ||||||||
| FaxNumber: | 3607340225 | ||||||||
| Practice Location | |||||||||
| Address1: | 2905 CONNELLY AVE | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982258225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607344181 | ||||||||
| FaxNumber: | 3607340225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2009 | ||||||||
| LastUpdateDate: | 03/19/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251G0304X | 00000897 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No ID Information.