Provider Demographics
NPI:1528339629
Name:SANDERS, KEITH (PT MHS SCS)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:PT MHS SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CAMERA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1037
Mailing Address - Country:US
Mailing Address - Phone:314-691-2696
Mailing Address - Fax:
Practice Address - Street 1:1000 CAMERA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1037
Practice Address - Country:US
Practice Address - Phone:314-691-2696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1105092251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports