MEDICARE: MR. JUSTIN W. SANDAL PT

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	225100000X	Physical Therapist	PTH3348	AL

General Provider Information

NPI Number	:	1386683365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUSTIN W. SANDAL PT

Provider Business Mailing Address
First Line	:	161 E UNIVERSITY DR
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36832-6725
Country	:	US
Telephone Number	:	334-826-2090
Fax Number	:	334-821-3191

Provider Business Practice Location Address
First Line	:	161 E UNIVERSITY DR
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36832-6725
Country	:	US
Telephone Number	:	334-826-2090
Fax Number	:	334-821-3191

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	10/18/2007

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