Provider Demographics
NPI:1053098012
Name:SANDU, TABITHA
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:SANDU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 TOWN CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6190
Mailing Address - Country:US
Mailing Address - Phone:541-639-5612
Mailing Address - Fax:
Practice Address - Street 1:945 TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6190
Practice Address - Country:US
Practice Address - Phone:541-639-5612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist