Provider Demographics
NPI:1154533958
Name:BURROUGH, SANDRA GAYLE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:GAYLE
Last Name:BURROUGH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BELVEDERE DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6624
Mailing Address - Country:US
Mailing Address - Phone:205-790-8448
Mailing Address - Fax:205-980-2528
Practice Address - Street 1:AMEDISYS HOME HEALTH
Practice Address - Street 2:1601-7TH STREET, NORTH, SUITE B
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045
Practice Address - Country:US
Practice Address - Phone:205-755-5509
Practice Address - Fax:205-755-9980
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist