Provider Demographics
NPI:1649406513
Name:SANDERS, ALISON NISSA (LMT)
Entity Type:Individual
Prefix:MISS
First Name:ALISON
Middle Name:NISSA
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:NISSA
Other - Last Name:DRESDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1803 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-2636
Mailing Address - Country:US
Mailing Address - Phone:541-591-1618
Mailing Address - Fax:
Practice Address - Street 1:1435 E MAIN ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-3407
Practice Address - Country:US
Practice Address - Phone:541-591-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163000172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR163000OtherSTATE LICENSE