Provider Demographics
NPI:1992733869
Name:WANDELL, SARAH LEWIS (PT)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LEWIS
Last Name:WANDELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 SOUNDSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-8921
Mailing Address - Country:US
Mailing Address - Phone:850-934-7964
Mailing Address - Fax:850-416-7348
Practice Address - Street 1:5025 SOUNDSIDE DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-8921
Practice Address - Country:US
Practice Address - Phone:850-416-7656
Practice Address - Fax:850-416-7348
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12840225100000X
FLPT 12840174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL810762900Medicaid
FL883137800Medicaid