Provider Demographics
NPI:1467675801
Name:SANDERS, MEGAN RENEE (MPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENEE
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 1:4137 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-3922
Mailing Address - Country:US
Mailing Address - Phone:314-771-6807
Mailing Address - Fax:
Practice Address - Street 1:17521 US HIGHWAY 69 S
Practice Address - Street 2:SUITE 120
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5376
Practice Address - Country:US
Practice Address - Phone:903-839-3600
Practice Address - Fax:903-839-4100
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002004652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist