Provider Demographics
NPI:1225205123
Name:SANDERSON, STEPHEN (PT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SANDERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 COUNTRY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-8894
Mailing Address - Country:US
Mailing Address - Phone:336-674-3276
Mailing Address - Fax:
Practice Address - Street 1:2100 COUNTRY VIEW DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-8894
Practice Address - Country:US
Practice Address - Phone:336-674-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-11
Last Update Date:2008-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist