Provider Demographics
NPI:1912936303
Name:SANDERS, PHYLLIS L (MED ATC)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:L
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MED ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 DAYBREAK CIR
Mailing Address - Street 2:SUITE A-150, #135
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1642
Mailing Address - Country:US
Mailing Address - Phone:443-535-0266
Mailing Address - Fax:
Practice Address - Street 1:6030 DAYBREAK CIR
Practice Address - Street 2:SUITE A-150, #135
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1642
Practice Address - Country:US
Practice Address - Phone:443-535-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD000306382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer