MEDICARE: SHAWNA SANDERS LPTA

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	225200000X	Physical Therapy Assistant	A6018	NC
2	225200000X	Physical Therapy Assistant	A6018	VA

General Provider Information

NPI Number	:	1982150199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNA SANDERS LPTA

Provider Business Mailing Address
First Line	:	3001 EDWARDS MILL RD STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-5243
Country	:	US
Telephone Number	:	919-781-4060
Fax Number	:	919-781-5246

Provider Business Practice Location Address
First Line	:	50 NEUSE RIVER PKWY STE 14
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27527-5275
Country	:	US
Telephone Number	:	919-781-4060
Fax Number	:	919-781-5246

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

Provider Enumeration Date	:	08/28/2016
Last Update Date	:	06/11/2024

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