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General NPI Number Information
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NPI Number | 1205854841
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Entity Type | Individual
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Provider Name | SANDRA L CONSBRUCK MPT
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Gender | Female
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3975 EMBASSY PKWY STE 103
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City | AKRON
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State | OH
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Zip | 44720-1763
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Country | US
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Telephone | 330-668-4080
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Fax | 330-665-1830
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Provider Business Mailing Address
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Address Line | 4666 EVERHART DR
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City | NORTH CANTON
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State | OH
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Zip | 44720-1108
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Country | US
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Telephone | 330-896-7039
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Fax | 330-665-1830
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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 | PT06672
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License Number State | OH
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