Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1013021245 |
---|---|
Provider Name | Ms. Barbara Ann Sanders |
First Address | Waco, TX 76710-4845 |
Second Address | Waco, TX 76711-1329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
682 | REGISTRATION (01) | IL |