Provider Demographics
NPI:1558008698
Name:SANDERSON, KATHERINE (DPT, CIMI, NTMTC, DC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:DPT, CIMI, NTMTC, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 S HAWAII ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-9476
Mailing Address - Country:US
Mailing Address - Phone:509-627-8161
Mailing Address - Fax:
Practice Address - Street 1:507 S HAWAII ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-9476
Practice Address - Country:US
Practice Address - Phone:509-627-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60083933208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation