Healthcare Provider Details

I. General information

NPI: 1073423521
Provider Name (Legal Business Name): FRED SANDLIN LMT, NCTMB, CES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 E PIMA ST
TUCSON AZ
85712-3314
US

IV. Provider business mailing address

3502 E EDISON ST
TUCSON AZ
85716-2911
US

V. Phone/Fax

Practice location:
  • Phone: 520-881-7337
  • Fax: 520-881-7340
Mailing address:
  • Phone: 520-820-2407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number16999
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: