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General NPI Number Information
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NPI Number | 1871546945
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Entity Type | Organization
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Legal Business Name | SANDER PHYSICAL THERAPY LTD.
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3195 STILLWATER AVE. STE. A
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City | PRESCOTT
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State | AZ
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Zip | 86305
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Country | US
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Telephone | 928-771-8156
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Fax | 928-771-9519
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Provider Business Mailing Address
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Address Line | PO BOX 10548
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City | PRESCOTT
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State | AZ
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Zip | 86304-0548
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Country | US
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Telephone | 928-771-8156
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Fax | 928-771-9519
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS DARCY D MYERS
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Credential | DPT
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Telephone | 928-771-8156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5331
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License Number State | AZ
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