Provider Demographics
NPI:1700974094
Name:SANDERS, CATHLEEN JOHNSON (MPT)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:JOHNSON
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 S LUPINE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-2728
Mailing Address - Country:US
Mailing Address - Phone:720-987-5477
Mailing Address - Fax:303-797-3449
Practice Address - Street 1:5855 S LUPINE DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2728
Practice Address - Country:US
Practice Address - Phone:720-987-5477
Practice Address - Fax:303-797-3449
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85800732Medicaid