Provider Demographics
NPI:1871721985
Name:ELLIOTT, SANDRA MARIE (PT, MPT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 PELLICANO DR STE A-9
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6064
Mailing Address - Country:US
Mailing Address - Phone:915-792-0812
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:11500 PELLICANO DR STE A-9
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6064
Practice Address - Country:US
Practice Address - Phone:915-792-0812
Practice Address - Fax:423-362-8684
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010543225100000X
TX1108256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist