Healthcare Provider Details

I. General information

NPI: 1922079003
Provider Name (Legal Business Name): ZANTHA ELAINE SANDERLIN MS,PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9815 WESTWOOD RD
MOUNTAINBURG AR
72946-3278
US

IV. Provider business mailing address

4322 W BEAVER LN
FAYETTEVILLE AR
72704-5535
US

V. Phone/Fax

Practice location:
  • Phone: 479-369-4456
  • Fax:
Mailing address:
  • Phone: 479-571-1875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2402
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: