MEDICARE: MRS. SONDRA GRANDFIELD

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	2306000523	VA

General Provider Information

NPI Number	:	1942504618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SONDRA GRANDFIELD

Provider Business Mailing Address
First Line	:	2737 COLDWELL ST
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-7604
Country	:	US
Telephone Number	:	757-427-2228
Fax Number	:

Provider Business Practice Location Address
First Line	:	2737 COLDWELL ST
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-7604
Country	:	US
Telephone Number	:	757-427-2228
Fax Number	:

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

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	01/10/2011

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