Provider Demographics
NPI:1346780962
Name:GERGEL, SANDRA VIGUERS (LAT, ATC, OPE-C)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:VIGUERS
Last Name:GERGEL
Suffix:
Gender:F
Credentials:LAT, ATC, OPE-C
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:VIGUERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC, OPE-C
Mailing Address - Street 1:616 COACH HILL CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-1736
Mailing Address - Country:US
Mailing Address - Phone:484-885-8314
Mailing Address - Fax:
Practice Address - Street 1:500 FIELDHOUSE LN
Practice Address - Street 2:
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-1307
Practice Address - Country:US
Practice Address - Phone:610-328-8327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PART0072232081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PJT821790679OtherBLUE CROSS BLUE SHIELD