Provider Demographics
NPI:1487955258
Name:SANDERS, ROBERT C
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:SANDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:C
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:691 SW 137TH LN
Mailing Address - Street 2:
Mailing Address - City:ASBURY
Mailing Address - State:MO
Mailing Address - Zip Code:64832-8156
Mailing Address - Country:US
Mailing Address - Phone:417-842-3663
Mailing Address - Fax:
Practice Address - Street 1:1 MT CARMEL WAY
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-7587
Practice Address - Country:US
Practice Address - Phone:620-232-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02187225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant