Healthcare Provider Details

I. General information

NPI: 1497875843
Provider Name (Legal Business Name): ERIK M SANDVIG P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12211 KAIN RD
GLEN ALLEN VA
23059-5720
US

IV. Provider business mailing address

12211 KAIN RD
GLEN ALLEN VA
23059-5720
US

V. Phone/Fax

Practice location:
  • Phone: 804-322-3264
  • Fax:
Mailing address:
  • Phone: 804-322-3264
  • Fax: 804-364-3567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305006683
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: