MEDICARE: SANDRA DUFTY DPT

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	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1982119400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA DUFTY DPT

Provider Business Mailing Address
First Line	:	1515 RIVER PL
Second Line	:
City	:	BRASELTON
State	:	GA
Zip	:	30517-5602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 RIVER PL
Second Line	:
City	:	BRASELTON
State	:	GA
Zip	:	30517-5602
Country	:	US
Telephone Number	:	770-848-6160
Fax Number	:

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

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	12/06/2017

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