Provider Demographics
NPI:1427107143
Name:BERTRAND, SANDRA L (MPT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10504 WAKEMAN DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-8040
Mailing Address - Country:US
Mailing Address - Phone:540-891-5326
Mailing Address - Fax:540-891-6316
Practice Address - Street 1:10504 WAKEMAN DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-8040
Practice Address - Country:US
Practice Address - Phone:540-891-5326
Practice Address - Fax:540-891-6316
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305005869OtherVIRGINIA STATE LICENSE