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General NPI Number Information
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NPI Number | 1235706458
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Entity Type | Individual
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Provider Name | MATTHEW T SANDERS PTA
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Gender | Male
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 93 SPRINGVIEW LN UNIT B
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8143
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Country | US
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Telephone | 843-797-5050
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Fax | 843-797-3633
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Provider Business Mailing Address
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Address Line | 2880 TRICOM ST
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-9171
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Country | US
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Telephone | 843-797-5050
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Fax | 843-797-3633
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 3364
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License Number State | SC
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