MEDICARE: SANDRA LOUISE RADER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT015016	PA
2	225100000X	Physical Therapist	40QA00420600	NJ

General Provider Information

NPI Number	:	1104821172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA LOUISE RADER PT

Provider Business Mailing Address
First Line	:	421 S BEST AVE
Second Line	:
City	:	WALNUTPORT
State	:	PA
Zip	:	18088-1217
Country	:	US
Telephone Number	:	610-760-1520
Fax Number	:	610-760-1721

Provider Business Practice Location Address
First Line	:	128 STATE HIGHWAY 94
Second Line	:
City	:	BLAIRSTOWN
State	:	NJ
Zip	:	07825
Country	:	US
Telephone Number	:	908-362-6172
Fax Number	:	908-362-6406

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	04/19/2026

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Directions to “ SANDRA LOUISE RADER PT” Practice Location

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