Sandra Burnley Short, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A4930 Issued in MD

Practice address

5 Otis CT
New Freedom, PA 17349-9755

Phone

(757) 291-4589

NPI assigned

Jun 6, 2018

Last updated

Jun 6, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Sandra Lea Burnley 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": "1528243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528243200000",
    "number": "1922590843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 OTIS CT",
            "city": "NEW FREEDOM",
            "state": "PA",
            "postal_code": "173499755",
            "telephone_number": "757-291-4589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 OTIS CT",
            "city": "NEW FREEDOM",
            "state": "PA",
            "postal_code": "173499755",
            "telephone_number": "757-291-4589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORT",
        "first_name": "SANDRA",
        "middle_name": "BURNLEY",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-06",
        "last_updated": "2018-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "MD",
            "license": "A4930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "BURNLEY",
            "middle_name": "LEA",
            "prefix": "MISS",
            "credential": "N/A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Erik Sprohge, PHD
• Stonebridge Dental LLC

• Physical Therapy Assistant in New Freedom, PA
• Providers in New Freedom, PA by specialty
• Physical Therapy Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2018; 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.