Provider Demographics
NPI:1972305290
Name:SANDERS, VANESSA RAE (LMT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:RAE
Last Name:SANDERS
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 W 1800 N STE A
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-8503
Mailing Address - Country:US
Mailing Address - Phone:801-217-3133
Mailing Address - Fax:801-528-5067
Practice Address - Street 1:1808 W 1800 N STE A
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-8503
Practice Address - Country:US
Practice Address - Phone:801-217-3133
Practice Address - Fax:801-217-3133
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61559396225700000X
UT14129438-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist