Healthcare Provider Details

I. General information

NPI: 1215607684
Provider Name (Legal Business Name): SANDRA BYNAKER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 CRAIN HWY
WALDORF MD
20603-4850
US

IV. Provider business mailing address

PO BOX 791217
BALTIMORE MD
21279-1217
US

V. Phone/Fax

Practice location:
  • Phone: 301-870-7366
  • Fax: 301-870-6717
Mailing address:
  • Phone: 301-932-4785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305214642
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28667
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: