Provider Demographics
NPI:1881024578
Name:SANDERS, CATHY
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 LAKELAND DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-5038
Mailing Address - Country:US
Mailing Address - Phone:601-942-2709
Mailing Address - Fax:601-944-9780
Practice Address - Street 1:1904 LAKELAND DR
Practice Address - Street 2:SUITE D
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5038
Practice Address - Country:US
Practice Address - Phone:601-942-2709
Practice Address - Fax:601-944-9780
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist