Healthcare Provider Details

I. General information

NPI: 1225593908
Provider Name (Legal Business Name): JASMINE MARIE SANDERS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MORGAN ST
CENTERTON AR
72719-5078
US

IV. Provider business mailing address

730 MORGAN ST
CENTERTON AR
72719-5078
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax: --
Mailing address:
  • Phone: --
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5608
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1315351
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: