Elizabeth Sandrock, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160005076 Issued in IL

Practice address

4343 Kennedy Dr
East Moline, IL 61244-4203

Phone

(309) 796-6600

NPI assigned

Dec 13, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Elizabeth Potter Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323734400000",
    "number": "1487922845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11623 ARBOR ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681442981",
            "telephone_number": "402-334-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4343 KENNEDY DR",
            "city": "EAST MOLINE",
            "state": "IL",
            "postal_code": "612444203",
            "telephone_number": "309-796-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDROCK",
        "first_name": "ELIZABETH",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-13",
        "last_updated": "2011-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160005076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "POTTER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapy Assistant in East Moline, IL
• Providers in East Moline, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.