Provider Demographics
NPI:1205278140
Name:SANDERS, KRIS TODD (MDT)
Entity type:Individual
Prefix:MR
First Name:KRIS
Middle Name:TODD
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720-1441
Mailing Address - Country:US
Mailing Address - Phone:541-647-4136
Mailing Address - Fax:541-573-1263
Practice Address - Street 1:559 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720-1441
Practice Address - Country:US
Practice Address - Phone:541-647-4136
Practice Address - Fax:541-573-1263
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist