Provider Demographics
NPI:1962546101
Name:SANDERS, DEREK D (AT,C)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:D
Last Name:SANDERS
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 PORTER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-3103
Mailing Address - Country:US
Mailing Address - Phone:517-281-0114
Mailing Address - Fax:
Practice Address - Street 1:123 LANSING ST
Practice Address - Street 2:REHAB AND WELLNESS
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1696
Practice Address - Country:US
Practice Address - Phone:517-543-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer