Provider Demographics
NPI:1871531814
Name:SANDRY, MICHAEL RAFIA (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RAFIA
Last Name:SANDRY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1627
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-1627
Mailing Address - Country:US
Mailing Address - Phone:406-273-3730
Mailing Address - Fax:
Practice Address - Street 1:106 TYLER WAY
Practice Address - Street 2:
Practice Address - City:LOLO
Practice Address - State:MT
Practice Address - Zip Code:59847-9714
Practice Address - Country:US
Practice Address - Phone:406-273-3730
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1263PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000342363Medicaid