Provider Demographics
NPI:1720384340
Name:SANDERS, SITA (LMT)
Entity Type:Individual
Prefix:
First Name:SITA
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 WILSON ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1756
Mailing Address - Country:US
Mailing Address - Phone:607-437-5825
Mailing Address - Fax:
Practice Address - Street 1:1010 12TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1534
Practice Address - Country:US
Practice Address - Phone:607-437-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17849225700000X
NY023533225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist