Provider Demographics
NPI:1780344770
Name:SANDERS, CHRISTOPHER ROBIN (ATC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROBIN
Last Name:SANDERS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14770 S MERLIN LOOP
Mailing Address - Street 2:
Mailing Address - City:EVANS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13637-3326
Mailing Address - Country:US
Mailing Address - Phone:585-813-1947
Mailing Address - Fax:
Practice Address - Street 1:20460 ANACONDA ROAD
Practice Address - Street 2:
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602
Practice Address - Country:US
Practice Address - Phone:585-813-1947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-18
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IA1149052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program