Provider Demographics
NPI:1154528404
Name:MCCLUSKEY, SANDY SUE (PTA)
Entity type:Individual
Prefix:MS
First Name:SANDY
Middle Name:SUE
Last Name:MCCLUSKEY
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 1:4704 N PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ROBARDS
Mailing Address - State:KY
Mailing Address - Zip Code:42452-9763
Mailing Address - Country:US
Mailing Address - Phone:270-521-2433
Mailing Address - Fax:
Practice Address - Street 1:2420 W 3RD ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-0328
Practice Address - Country:US
Practice Address - Phone:270-685-3141
Practice Address - Fax:270-684-4867
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01452225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant