Provider Demographics
NPI:1417200577
Name:REDDEROTH, SANDRA M (MS, RCEP)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:M
Last Name:REDDEROTH
Suffix:
Gender:F
Credentials:MS, RCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 LIVE OAK CT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2571
Mailing Address - Country:US
Mailing Address - Phone:770-713-2631
Mailing Address - Fax:
Practice Address - Street 1:800 LIVE OAK CT
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2571
Practice Address - Country:US
Practice Address - Phone:770-713-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist