MEDICARE: SITA SANDERS LMT

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	225700000X	Massage Therapist	17849	OR
2	225700000X	Massage Therapist	023533	NY

General Provider Information

NPI Number	:	1720384340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SITA SANDERS LMT

Provider Business Mailing Address
First Line	:	1121 WILSON ST
Second Line	:	APT. 1
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-1756
Country	:	US
Telephone Number	:	607-437-5825
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 12TH ST
Second Line	:	SUITE B
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-1534
Country	:	US
Telephone Number	:	607-437-5825
Fax Number	:

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

Provider Enumeration Date	:	01/28/2011
Last Update Date	:	01/28/2011

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Directions to “ SITA SANDERS LMT” Practice Location

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