MEDICARE: MRS. SANDRA LU HOWERTON 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	13488	CA

General Provider Information

NPI Number	:	1689059933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA LU HOWERTON PT

Provider Business Mailing Address
First Line	:	383 GOLDEN VINE CT
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-6705
Country	:	US
Telephone Number	:	805-581-2335
Fax Number	:

Provider Business Practice Location Address
First Line	:	607 ELMIRA RD
Second Line	:	SUITE 239
City	:	VACAVILLE
State	:	CA
Zip	:	95687-4655
Country	:	US
Telephone Number	:	805-581-2335
Fax Number	:

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

Provider Enumeration Date	:	07/29/2015
Last Update Date	:	07/29/2015

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