Provider Demographics
NPI:1871878603
Name:VANDEE, SARA (PTA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:VANDEE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-9435
Mailing Address - Country:US
Mailing Address - Phone:814-332-9237
Mailing Address - Fax:814-333-2163
Practice Address - Street 1:31 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-9435
Practice Address - Country:US
Practice Address - Phone:814-332-9237
Practice Address - Fax:814-333-2163
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1002626225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant