Healthcare Provider Details

I. General information

NPI: 1588403836
Provider Name (Legal Business Name): HAILEY DANELLA SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SOMERSET AVE
WINDBER PA
15963-1331
US

IV. Provider business mailing address

511 E GRANT AVE
ALTOONA PA
16602-5319
US

V. Phone/Fax

Practice location:
  • Phone: 814-467-3000
  • Fax:
Mailing address:
  • Phone: 814-505-7842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: