Provider Demographics
NPI:1821654419
Name:SANDERS, SABLE M (PTA)
Entity Type:Individual
Prefix:MS
First Name:SABLE
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 FLORA GENE AVE W STE D
Mailing Address - Street 2:
Mailing Address - City:WIGGINS
Mailing Address - State:MS
Mailing Address - Zip Code:39577-5010
Mailing Address - Country:US
Mailing Address - Phone:601-523-1994
Mailing Address - Fax:601-523-1995
Practice Address - Street 1:321 FLORA GENE AVE W STE D
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-5010
Practice Address - Country:US
Practice Address - Phone:601-523-1994
Practice Address - Fax:601-523-1995
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA6648225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant