Provider Demographics
NPI:1871905240
Name:SCANLAN, SANDRA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:SCANLAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 E SANDSTONE CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-3260
Mailing Address - Country:US
Mailing Address - Phone:224-406-0713
Mailing Address - Fax:
Practice Address - Street 1:1956 W SPRING RIDGE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1220
Practice Address - Country:US
Practice Address - Phone:224-406-0713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10766208100000X
IL070020631208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation