Provider Demographics
NPI:1063904068
Name:SANDRA H SUBLETT, PT, LLC
Entity type:Organization
Organization Name:SANDRA H SUBLETT, PT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:HEALD
Authorized Official - Last Name:SUBLETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, CLT
Authorized Official - Phone:319-377-0937
Mailing Address - Street 1:227 NORTHLAND CT NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-6226
Mailing Address - Country:US
Mailing Address - Phone:319-377-0937
Mailing Address - Fax:319-377-0948
Practice Address - Street 1:227 NORTHLAND CT NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-6226
Practice Address - Country:US
Practice Address - Phone:319-899-6225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty