Healthcare Provider Details

I. General information

NPI: 1376575548
Provider Name (Legal Business Name): SANDRA FAY ROLA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS SANDRA FAY DOWNARD

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 TAMIAMI TRL S SUITE 207
VENICE FL
34285-2402
US

IV. Provider business mailing address

410 GRANT RD
VENICE FL
34293-3147
US

V. Phone/Fax

Practice location:
  • Phone: 941-484-2471
  • Fax: 941-484-5487
Mailing address:
  • Phone: 941-587-1303
  • Fax: 941-484-5487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA13373
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: