Provider Demographics
NPI:1487177994
Name:SANDERSON, LAURA (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
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 1:28400 SPEIDEL RD
Mailing Address - Street 2:
Mailing Address - City:EAST ROCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:44625-9764
Mailing Address - Country:US
Mailing Address - Phone:330-324-3735
Mailing Address - Fax:
Practice Address - Street 1:1320 MERCY DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2614
Practice Address - Country:US
Practice Address - Phone:330-627-8873
Practice Address - Fax:330-627-8877
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist