1336366301 NPI number — KRISTIN LANDIS SANDERS PT, MPT, PCS

Table of content: KRISTIN LANDIS SANDERS PT, MPT, PCS (NPI 1336366301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336366301 NPI number — KRISTIN LANDIS SANDERS PT, MPT, PCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDERS
Provider First Name:
KRISTIN
Provider Middle Name:
LANDIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, MPT, PCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BALL
Provider Other First Name:
KRISTIN
Provider Other Middle Name:
LANDIS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336366301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 KELLY MEADOWS LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARRENTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-226-1167
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
69 DEANE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUCKERSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22968-3482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-481-3524
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  2305208783 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7212491 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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