Provider Demographics
NPI:1811197437
Name:SANDERS, ESTHER M (LMP)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:BOVILL
Mailing Address - State:ID
Mailing Address - Zip Code:83806-0229
Mailing Address - Country:US
Mailing Address - Phone:208-826-3583
Mailing Address - Fax:208-826-3583
Practice Address - Street 1:411 2ND AVE
Practice Address - Street 2:
Practice Address - City:BOVILL
Practice Address - State:ID
Practice Address - Zip Code:83806
Practice Address - Country:US
Practice Address - Phone:208-826-3583
Practice Address - Fax:208-826-3583
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-22
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012511225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist