Healthcare Provider Details

I. General information

NPI: 1154270155
Provider Name (Legal Business Name): MICHELLE SANDOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NE MOCK AVE
BLUE SPRINGS MO
64014-2503
US

IV. Provider business mailing address

325 E PARTRIDGE AVE
INDEPENDENCE MO
64055-1452
US

V. Phone/Fax

Practice location:
  • Phone: 816-898-2314
  • Fax: 816-898-2314
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: