Evita E. Sandoval, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

104-0000163 Issued in VT

Practice address

569 Main Street
Lyndonville, VT 05851

Phone

(802) 626-4224

Fax

(802) 626-5042

NPI assigned

Aug 27, 2009

Last updated

May 3, 2016By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northern Physical Therapy PC

  • Physical Therapy Clinic/Center
  • Lyndonville, VT
  • NPI 1164509980
  NPD (past)

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

{
    "created_epoch": "1251331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462233600000",
    "number": "1679706360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1346",
            "city": "LYNDONVILLE",
            "state": "VT",
            "postal_code": "05851",
            "telephone_number": "802-626-4224",
            "fax_number": "802-626-5042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "569 MAIN STREET",
            "city": "LYNDONVILLE",
            "state": "VT",
            "postal_code": "05851",
            "telephone_number": "802-626-4224",
            "fax_number": "802-626-5042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDOVAL",
        "first_name": "EVITA",
        "middle_name": "E.",
        "name_prefix": "Ms.",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-27",
        "last_updated": "2016-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "VT",
            "license": "104-0000163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valerie K Pollock, PTA, CNMT
• Post Acute Specialists of Vermont PLC
• Horace Oliver Reider, M.D.
• Riverside Life Enrichment Center Inc
• Aimee E Rozum, LMHC, LCMHC, ATR-BC
• Connie L Sanville, M.S.
• William Alan Sargent, MD
• Anthony Lawrence Sgherza, PT, ATC
• Rose M Sheehan, LADC
• Sky William Shover

• Athletic Trainer in Lyndonville, VT
• Providers in Lyndonville, VT by specialty
• Athletic Trainer in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2016; 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.