Provider Demographics
NPI:1083854145
Name:SANDERLIN, NANCY RYAN (PT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:RYAN
Last Name:SANDERLIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 CRIMSON STAR DRIVE
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023
Mailing Address - Country:US
Mailing Address - Phone:720-256-4700
Mailing Address - Fax:303-465-0663
Practice Address - Street 1:1952 E 7000 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6877
Practice Address - Country:US
Practice Address - Phone:801-942-3311
Practice Address - Fax:801-495-5303
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7036251E00000X
COPTL.0007036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No251E00000XAgenciesHome Health