Individual provider Active NPI

Carl Andrew Sandstrom, MSPT

  • Physical Therapist
  • Warren, PA
National Provider Identifier
1952387045
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT007634L Issued in PA
Practice address
2265 Market St
Suite a
Warren, PA 16365-4625
Phone
(814) 726-9050
Fax
(814) 726-9629
NPI assigned
Dec 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X DAPT000113 PA
Physical Therapist 225100000X PT007634L PA Primary

Addresses

Primary practice location

2265 Market St
Suite a
Warren, PA 16365-4625

Mailing address

2265 Market St Ste a
Warren, PA 16365-4682
Phone (814) 726-9050

Other identifiers 1

IdentifierTypeStateIssuer
1028776920001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2265 Market St a
Warren, PA 16365-4682

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DAPT000113PAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Clinical Therapeutics Inc Physical Therapist CurrentSince Nov 17, 1998 Accepting new patients

Locations

300 State St
Ste 104
Erie, PA 16507
Phone (814) 454-5251

2265 Market St
Ste A
Warren, PA 16365
Phone (814) 726-9050

Interoperability endpoints

  • Direct secure messaging: andys@ctiphysicaltherapy.medentdirect.com

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1952387045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2265 MARKET ST STE A",
            "city": "WARREN",
            "state": "PA",
            "postal_code": "163654682",
            "telephone_number": "814-726-9050",
            "fax_number": "814-726-9629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2265 MARKET ST",
            "address_2": "SUITE A",
            "city": "WARREN",
            "state": "PA",
            "postal_code": "163654625",
            "telephone_number": "814-726-9050",
            "fax_number": "814-726-9629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDSTROM",
        "first_name": "CARL",
        "middle_name": "ANDREW",
        "credential": "MSPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-20",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "DAPT000113",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT007634L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1028776920001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.