Provider Demographics
NPI:1528719952
Name:CARRETTA, SANDRA LANE (RMT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LANE
Last Name:CARRETTA
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6280
Mailing Address - Country:US
Mailing Address - Phone:410-259-2859
Mailing Address - Fax:
Practice Address - Street 1:9 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-6280
Practice Address - Country:US
Practice Address - Phone:410-259-2859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD428716225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist