MEDICARE: ERIN NICOLE SANDERS PT, MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	005329	KY

General Provider Information

NPI Number	:	1376793661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN NICOLE SANDERS PT, MSPT

Provider Business Mailing Address
First Line	:	125 SOUTH SECOND ST PO BOX 422
Second Line	:
City	:	BURGIN
State	:	KY
Zip	:	40310-0422
Country	:	US
Telephone Number	:	859-319-7871
Fax Number	:

Provider Business Practice Location Address
First Line	:	5006 ATWOOD DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-8179
Country	:	US
Telephone Number	:	859-623-2057
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	09/24/2008

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