Healthcare Provider Details

I. General information

NPI: 1376307132
Provider Name (Legal Business Name): REAGAN LYN SANDFORD PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 CROW LN STE 201
MYRTLE BEACH SC
29577-1663
US

IV. Provider business mailing address

2187 W SOUTH LOOP STE A
STEPHENVILLE TX
76401-3921
US

V. Phone/Fax

Practice location:
  • Phone: 843-848-5220
  • Fax: 843-848-5225
Mailing address:
  • Phone: 254-918-0724
  • Fax: 254-918-0883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13343
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1388809
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: