Active NPI
Jeffrey Sandy
- Physical Therapist
- Buckhannon, WV
National Provider Identifier
1174068894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 003207
- Practice address
- 103 Professional Arts Plaza Dr
Buckhannon, WV 26201-4698 - Phone
- (304) 642-9208
- NPI assigned
- Jan 4, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 003207 | WV | Primary |
Addresses
Primary practice location
103 Professional Arts Plaza Dr
Buckhannon, WV 26201-4698
Mailing address
103 Professional Arts Plaza Dr
Buckhannon, WV 26201-4698
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170417000822 | WV | Practitioner - Physical Therapist in Private Practice | 1052697588 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003207 | WV | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1483488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483488000000",
"number": "1174068894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 PROFESSIONAL ARTS PLAZA DR",
"city": "BUCKHANNON",
"state": "WV",
"postal_code": "262014698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 PROFESSIONAL ARTS PLAZA DR",
"city": "BUCKHANNON",
"state": "WV",
"postal_code": "262014698",
"telephone_number": "304-642-9208"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDY",
"first_name": "JEFFREY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-01-04",
"last_updated": "2017-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "003207",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buckhannon, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.