Provider Demographics
NPI:1700286861
Name:SANDERS, JAMES (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 ARDEN LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3543
Mailing Address - Country:US
Mailing Address - Phone:501-454-5431
Mailing Address - Fax:501-336-0119
Practice Address - Street 1:1065 CLAYTON ST
Practice Address - Street 2:SUITE 9
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4329
Practice Address - Country:US
Practice Address - Phone:501-328-5878
Practice Address - Fax:501-336-0119
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist