Provider Demographics
NPI:1285889980
Name:SASARITA, SAUNDRA (OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:
Last Name:SASARITA
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SHERMAN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2564
Mailing Address - Country:US
Mailing Address - Phone:651-241-7560
Mailing Address - Fax:
Practice Address - Street 1:360 SHERMAN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2564
Practice Address - Country:US
Practice Address - Phone:651-241-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104299261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy