Provider Demographics
NPI:1861451890
Name:SANDERSON, AMY CHRISTIAENS (BS, PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTIAENS
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:BS, PT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:KATHLEEN
Other - Last Name:CHRISTIAENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, PT
Mailing Address - Street 1:30905 S PINE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-9306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 E WESTVIEW CT
Practice Address - Street 2:SUITE A
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1376
Practice Address - Country:US
Practice Address - Phone:509-559-5038
Practice Address - Fax:509-559-5027
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA123697OtherLABOR & INDUSTRIES
WA7076995Medicaid
WAAB06021Medicare ID - Type Unspecified