Healthcare Provider Details

I. General information

NPI: 1740454461
Provider Name (Legal Business Name): SANDRA DEE VIGH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3308 FRANKLIN RD SW
ROANOKE VA
24014-1310
US

IV. Provider business mailing address

3308 FRANKLIN RD SW
ROANOKE VA
24014-1310
US

V. Phone/Fax

Practice location:
  • Phone: 540-344-2116
  • Fax: 540-344-2118
Mailing address:
  • Phone: 540-344-2116
  • Fax: 540-344-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2305205390
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: