Healthcare Provider Details

I. General information

NPI: 1770436602
Provider Name (Legal Business Name): SANDRA SURMACZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5009 HONEYGO CENTER DR STE 209
PERRY HALL MD
21128-9842
US

IV. Provider business mailing address

5009 HONEYGO CENTER DR STE 209
PERRY HALL MD
21128-9842
US

V. Phone/Fax

Practice location:
  • Phone: 443-725-2150
  • Fax:
Mailing address:
  • Phone: 443-725-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA5207
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: