Provider Demographics
NPI:1790554384
Name:SANDERSTEIN, LORRAINE (MT)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:SANDERSTEIN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5326 VISTA RUN DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4620
Mailing Address - Country:US
Mailing Address - Phone:210-646-2583
Mailing Address - Fax:
Practice Address - Street 1:5326 VISTA RUN DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-4620
Practice Address - Country:US
Practice Address - Phone:210-952-5016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-25
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT026476225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist