Provider Demographics
NPI:1649466756
Name:SANDER, JESSICA LEIGH (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:SANDER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19868 MAYAS LN
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-3385
Mailing Address - Country:US
Mailing Address - Phone:302-841-4988
Mailing Address - Fax:302-644-1397
Practice Address - Street 1:1200 SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-853-0663
Practice Address - Fax:302-644-1397
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist