Healthcare Provider Details

I. General information

NPI: 1679451520
Provider Name (Legal Business Name): ALEXANDRA SANDAGER MSAT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 HENRY LUCKOW LN
BELVIDERE IL
61008-1702
US

IV. Provider business mailing address

704 N SPRINGFIELD AVE
ROCKFORD IL
61101-5045
US

V. Phone/Fax

Practice location:
  • Phone: 815-544-6967
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096.016045
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: