1871546945 NPI number — SANDER PHYSICAL THERAPY LTD.

Table of content: (NPI 1871546945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871546945 NPI number — SANDER PHYSICAL THERAPY LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDER PHYSICAL THERAPY LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871546945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10548
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86304-0548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-771-8156
Provider Business Mailing Address Fax Number:
928-771-9519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3195 STILLWATER AVE.
Provider Second Line Business Practice Location Address:
STE. A
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-771-8156
Provider Business Practice Location Address Fax Number:
928-771-9519
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MYERS
Authorized Official First Name:
DARCY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
928-771-8156

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5331 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 564973 . This is a "AHCCCS INDIVIDUAL #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 099382 . This is a "AHCCCS GROUP BILLING #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0409500 . This is a "BLUE CROSS BLUE SHIELD #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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