Provider Demographics
NPI:1811072937
Name:SANDERS, JEREMIAH SETH (ATC/LAT)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:SETH
Last Name:SANDERS
Suffix:
Gender:M
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:CAVE CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72521-9410
Mailing Address - Country:US
Mailing Address - Phone:870-283-4397
Mailing Address - Fax:
Practice Address - Street 1:1699 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7302
Practice Address - Country:US
Practice Address - Phone:870-262-1271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT 3652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer