# SANDY SPORTSCARE PHYSICAL THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376193425
- **Authorized official:** DOMONIQUE MARIE RUSCITTI (BILLER AND CONTRACTING SPECIALIST)
- **Authorized official phone:** (971) 274-2861

## Contact information

- **Practice address:** 16621 CHAMPION WAY STE 100, SANDY, OR 97055-7258
- **Practice address phone:** (503) 668-5321
- **Mailing address:** 16621 CHAMPION WAY STE 100, SANDY, OR 97055-7258
- **Mailing address phone:** (503) 668-5321

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 09/19/2019
- **Last updated:** 09/19/2019