Provider Demographics
NPI:1306992540
Name:SANDERS, STEVEN MICHAEL (PT)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MICHAEL
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 1:1600 SE J ST # 4
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-6804
Mailing Address - Country:US
Mailing Address - Phone:479-273-9933
Mailing Address - Fax:479-273-9935
Practice Address - Street 1:1600 SE J ST # 4
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6804
Practice Address - Country:US
Practice Address - Phone:479-273-9933
Practice Address - Fax:479-273-9935
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 2296225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR796247OtherHEALTHLINK
AR712695OtherACN GROUP
AR19435OtherEVOLUTIONS
208251201OtherTRICARE
AR164269721Medicaid
AR20825120100OtherQUALCHOICE
AR5A315OtherBCBS
AR5A315Medicare PIN