MEDICARE: SANDRA MARIE ELLIOTT PT, MPT

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	1108256	TX

General Provider Information

NPI Number	:	1871721985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA MARIE ELLIOTT PT, MPT

Provider Business Mailing Address
First Line	:	2835 E BROWN RD STE 101
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-5470
Country	:	US
Telephone Number	:	915-792-0812
Fax Number	:	423-362-8684

Provider Business Practice Location Address
First Line	:	2835 E BROWN RD STE 101
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-5470
Country	:	US
Telephone Number	:	480-807-6644
Fax Number	:

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

Provider Enumeration Date	:	06/26/2009
Last Update Date	:	05/15/2026

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