Healthcare Provider Details

I. General information

NPI: 1154465615
Provider Name (Legal Business Name): KANDRA ROGERSON SANKOVICH M.S., ATC, CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 N GALLATIN AVE
UNIONTOWN PA
15401-3009
US

IV. Provider business mailing address

121 MEADOWVIEW CT
UNIONTOWN PA
15401-8700
US

V. Phone/Fax

Practice location:
  • Phone: 724-437-7500
  • Fax: 724-437-4492
Mailing address:
  • Phone: 724-439-4020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT001816A
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: