Healthcare Provider Details

I. General information

NPI: 1013021245
Provider Name (Legal Business Name): BARBARA ANN SANDERS RKT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BARBARA ANN SANDERS KINESIOTHERAPIST

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 MEMORIAL DR
WACO TX
76711-1329
US

IV. Provider business mailing address

1413 LAWRENCE DR
WACO TX
76710-4845
US

V. Phone/Fax

Practice location:
  • Phone: 254-297-3362
  • Fax: 254-743-0028
Mailing address:
  • Phone: 254-743-0241
  • Fax: 254-743-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: