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General NPI Number Information
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NPI Number | 1154854859
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Entity Type | Individual
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Provider Name | JOHN MARTIN SANDSTROM
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Gender | Male
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 615 N EMROY AVE
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City | ELMHURST
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State | IL
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Zip | 60126-1940
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Country | US
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Telephone | 630-806-1518
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Fax |
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Provider Business Mailing Address
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Address Line | 615 N EMROY AVE
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City | ELMHURST
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State | IL
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Zip | 60126
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Country | US
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Telephone | 630-806-1518
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070009936
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License Number State | IL
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