Healthcare Provider Details

I. General information

NPI: 1063904068
Provider Name (Legal Business Name): SANDRA H SUBLETT, PT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 NORTHLAND CT NE
CEDAR RAPIDS IA
52402-6226
US

IV. Provider business mailing address

227 NORTHLAND CT NE
CEDAR RAPIDS IA
52402-6226
US

V. Phone/Fax

Practice location:
  • Phone: 319-899-6225
  • Fax:
Mailing address:
  • Phone: 319-377-0937
  • Fax: 319-377-0948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. SANDRA HEALD SUBLETT
Title or Position: OWNER/MANAGER
Credential: PT, DPT, OCS, CLT
Phone: 319-377-0937