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General NPI Number Information
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NPI Number | 1578615845
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Entity Type | Individual
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Provider Name | JENNIFER MERRILL SANDY P.T.A.
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 281 W 24TH ST SUITE 126
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City | YUMA
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State | AZ
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Zip | 85364-8500
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Country | US
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Telephone | 928-344-6856
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Fax | 928-344-6930
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Provider Business Mailing Address
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Address Line | 281 W 24TH ST SUITE 126
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City | YUMA
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State | AZ
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Zip | 85364-8500
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Country | US
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Telephone | 928-344-6856
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Fax | 928-344-6930
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 0046A
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License Number State | AZ
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