Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 7341 | MN |
NPI | 1063468767 |
---|---|
Provider Name | Stacy D Sanders |
First Address | Woodbury, MN 55125-4925 |
Second Address | Woodbury, MN 55125-2522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 07/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063468767 | (05) | MN |
650001460 | MEDICARE (01) | MN |
P00326353 | RAILROAD MEDICARE (01) | MN |