Provider Demographics
NPI:1679504567
Name:SANDERS, BRENT M (LMP)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2607 BRIDGEPORT WAY WEST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4725
Mailing Address - Country:US
Mailing Address - Phone:253-564-2353
Mailing Address - Fax:253-565-1286
Practice Address - Street 1:2607 BRIDGEPORT WAY WEST
Practice Address - Street 2:SUITE 1A
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4725
Practice Address - Country:US
Practice Address - Phone:253-564-2353
Practice Address - Fax:253-565-1286
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMA00008118174400000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist