Provider Demographics
NPI:1447586656
Name:SANDERSON, MARCIA L (PT)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
Last Name:SANDERSON
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 1:25 PLAZA DR.
Mailing Address - Street 2:UNIT 6
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-289-1010
Mailing Address - Fax:207-289-1011
Practice Address - Street 1:25 PLAZA DR.
Practice Address - Street 2:UNIT 6
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-289-1010
Practice Address - Fax:207-289-1011
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT292225100000X
MEMT3823225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist