MEDICARE: TABITHA SANDU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1053098012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABITHA SANDU

Provider Business Mailing Address
First Line	:	945 TOWN CENTRE DR
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-6190
Country	:	US
Telephone Number	:	541-639-5612
Fax Number	:

Provider Business Practice Location Address
First Line	:	945 TOWN CENTRE DR
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-6190
Country	:	US
Telephone Number	:	541-639-5612
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2023
Last Update Date	:	06/30/2023

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Directions to “ TABITHA SANDU ” Practice Location

Language	Start Address	Practice Location

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