Sandra Marie Pettiford, P. T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

1005 State St
East Saint Louis, IL 62201-1907

Phone

(618) 646-3960

Fax

(618) 646-3968

NPI assigned

May 11, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Sandra Marie Lee 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": "1178841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710192703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 GLEN MOR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622213482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 STATE ST",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622011907",
            "telephone_number": "618-646-3960",
            "fax_number": "618-646-3968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIFORD",
        "first_name": "SANDRA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "P. T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05000547A",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "R0055",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "LEE",
            "middle_name": "MARIE",
            "credential": "P. T.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mary Beth E Neufeld-Wall, MSW, LCSW
• Charles V Nye Jr., M.D.
• Osh-Il Physicians Group LLC
• Rina S. Patney, M.D.
• Marianna Peterson, MSW
• Tina Yvonne Pettiford, LPC
• Verna J. Porter, MD
• Adam Pruett, RDN
• Kayla Ann Pryor, APRN
• Leah Pulley

• Physical Therapist in East Saint Louis, IL
• Providers in East Saint Louis, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.