Healthcare Provider Details

I. General information

NPI: 1821473380
Provider Name (Legal Business Name): MS. SANDRA WARE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 PALM SPRINGS DR, STE 345
ORLANDO FL
32828
US

IV. Provider business mailing address

1038 SENECA FALLS DR
ORLANDO FL
32828-6605
US

V. Phone/Fax

Practice location:
  • Phone: 407-494-0644
  • Fax: 407-494-0644
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 25351
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: