Healthcare Provider Details

I. General information

NPI: 1871721985
Provider Name (Legal Business Name): SANDRA MARIE ELLIOTT PT, MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 E BROWN RD STE 101
MESA AZ
85213-5470
US

IV. Provider business mailing address

2835 E BROWN RD STE 101
MESA AZ
85213-5470
US

V. Phone/Fax

Practice location:
  • Phone: 480-807-6644
  • Fax:
Mailing address:
  • Phone: 915-792-0812
  • Fax: 423-362-8684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1108256
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: