Provider Demographics
NPI:1003944828
Name:SANDERS, TAMMY SUE (MPT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:SUE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 SW WESTER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-1814
Mailing Address - Country:US
Mailing Address - Phone:904-607-4007
Mailing Address - Fax:386-961-0223
Practice Address - Street 1:1049 SW WESTER DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-1814
Practice Address - Country:US
Practice Address - Phone:904-607-4007
Practice Address - Fax:386-961-0223
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist