Provider Demographics
NPI:1750572590
Name:SANDERS, RICK (MS RPT)
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MS RPT
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 1698
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121-0019
Mailing Address - Country:US
Mailing Address - Phone:205-625-4600
Mailing Address - Fax:205-625-4607
Practice Address - Street 1:28256 STATE HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-1659
Practice Address - Country:US
Practice Address - Phone:205-625-4600
Practice Address - Fax:205-625-4607
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP03201Medicare UPIN