Healthcare Provider Details

I. General information

NPI: 1114239662
Provider Name (Legal Business Name): BRIAN F SANDERS D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W LEGION RD
BRAWLEY CA
92227-7713
US

IV. Provider business mailing address

317 N EL CAMINO REAL #210
ENCINITAS CA
92024-2811
US

V. Phone/Fax

Practice location:
  • Phone: 760-351-7125
  • Fax: 760-351-7128
Mailing address:
  • Phone: 760-634-0248
  • Fax: 760-634-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 36821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: