MEDICARE: MS. SANDRA PAIGE NUNN PTA

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	225200000X	Physical Therapy Assistant	P160442332	WA

General Provider Information

NPI Number	:	1861642795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA PAIGE NUNN PTA

Provider Business Mailing Address
First Line	:	1302 VIRGINIA ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-4847
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	316 E MCLEOD RD STE 101
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-6491
Country	:	US
Telephone Number	:	360-734-5410
Fax Number	:

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

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	12/06/2023

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