Provider Demographics
NPI:1174679161
Name:SANDERS, LAURA K (LPTA, ATRIC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:K
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LPTA, ATRIC
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:K
Other - Last Name:LESLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA, ATRIC
Mailing Address - Street 1:3701 BELLEMEADE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0137
Mailing Address - Country:US
Mailing Address - Phone:812-479-1411
Mailing Address - Fax:812-437-2636
Practice Address - Street 1:3701 BELLEMEADE AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0137
Practice Address - Country:US
Practice Address - Phone:812-479-1411
Practice Address - Fax:812-437-2636
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001811A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant