Provider Demographics
NPI:1992083604
Name:SANDRY, MARCELLA D (PT)
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:D
Last Name:SANDRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARCELLA
Other - Middle Name:D
Other - Last Name:HAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:111 SUNNYVIEW LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3164
Mailing Address - Country:US
Mailing Address - Phone:406-752-3597
Mailing Address - Fax:406-756-7605
Practice Address - Street 1:111 SUNNYVIEW LN
Practice Address - Street 2:SUITE B
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3164
Practice Address - Country:US
Practice Address - Phone:406-752-3597
Practice Address - Fax:406-756-7605
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist