Provider Demographics
NPI:1306948096
Name:SANDERSON, DAVID WESLEY (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WESLEY
Last Name:SANDERSON
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 1:631 E. CRAWFORD ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-5116
Mailing Address - Country:US
Mailing Address - Phone:785-825-2323
Mailing Address - Fax:785-825-2325
Practice Address - Street 1:631 E. CRAWFORD ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-5116
Practice Address - Country:US
Practice Address - Phone:785-825-2323
Practice Address - Fax:785-825-2325
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS140466OtherBLUE CROSS AND SHIELD
KS200003430BMedicaid
KSP82252Medicare UPIN
KS200003430BMedicaid