MEDICARE: CARLIE SANDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	5238	MN

General Provider Information

NPI Number	:	1053206318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLIE SANDER

Provider Business Mailing Address
First Line	:	924 MCKINLEY AVE
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	924 MCKINLEY AVE
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3504
Country	:	US
Telephone Number	:	218-234-2907
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2025
Last Update Date	:	04/25/2026

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Directions to “ CARLIE SANDER ” Practice Location

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