Provider Demographics
NPI:1871546945
Name:SANDER PHYSICAL THERAPY LTD.
Entity type:Organization
Organization Name:SANDER PHYSICAL THERAPY LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:928-771-8156
Mailing Address - Street 1:PO BOX 10548
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0548
Mailing Address - Country:US
Mailing Address - Phone:928-771-8156
Mailing Address - Fax:928-771-9519
Practice Address - Street 1:3195 STILLWATER AVE.
Practice Address - Street 2:STE. A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305
Practice Address - Country:US
Practice Address - Phone:928-771-8156
Practice Address - Fax:928-771-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ564973OtherAHCCCS INDIVIDUAL #
AZ099382OtherAHCCCS GROUP BILLING #
AZAZ0409500OtherBLUE CROSS BLUE SHIELD #