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General NPI Number Information
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NPI Number | 1346560596
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Entity Type | Individual
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Provider Name | LISA A SANDERS PTA
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Gender | Female
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Dates
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Enumeration Date | 06/09/2010
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Last Update Date | 06/09/2010
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Provider Practice Location Address
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Address Line | 1702 HILLCREST DR
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City | BELLEVUE
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State | NE
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Zip | 68005-3652
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Country | US
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Telephone | 402-682-6569
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Fax |
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Provider Business Mailing Address
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Address Line | 1602 GRANDVIEW AVE APT 5
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City | PAPILLION
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State | NE
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Zip | 68046-5813
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Country | US
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Telephone | 402-860-1851
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Fax |
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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 | 916
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License Number State | NE
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