Provider Demographics
NPI:1669684387
Name:SANDER, ROBERT GLENNON (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GLENNON
Last Name:SANDER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-2906
Mailing Address - Country:US
Mailing Address - Phone:636-239-3486
Mailing Address - Fax:636-239-3786
Practice Address - Street 1:1935 PRAIRIE DELL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-4328
Practice Address - Country:US
Practice Address - Phone:636-584-0556
Practice Address - Fax:636-584-7049
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist