Provider Demographics
NPI:1891978987
Name:MADDEN, SANDRA S (PT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:S
Last Name:MADDEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10821 CLYBURN PARK DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-4887
Mailing Address - Country:US
Mailing Address - Phone:505-268-7083
Mailing Address - Fax:
Practice Address - Street 1:4308 CARLISLE BLVD NE STE 209
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4849
Practice Address - Country:US
Practice Address - Phone:505-828-0232
Practice Address - Fax:505-823-1051
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist