Provider Demographics
NPI:1659426450
Name:SAUNDERS PHYSICAL THERAPY AND SPORTS PERFORMANCE PLLC
Entity Type:Organization
Organization Name:SAUNDERS PHYSICAL THERAPY AND SPORTS PERFORMANCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:SAUNDERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-694-8808
Mailing Address - Street 1:14 THIELLS MOUNT IVY RD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3021
Mailing Address - Country:US
Mailing Address - Phone:845-694-8808
Mailing Address - Fax:845-694-8809
Practice Address - Street 1:14 THIELLS MOUNT IVY RD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3021
Practice Address - Country:US
Practice Address - Phone:845-694-8808
Practice Address - Fax:845-694-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQAWEC1Medicare PIN