Individual
STACY D SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2090 WOODWINDS DR, WOODBURY, MN 55125-2522
(651) 968-5801
(651) 968-5899
Mailing address
710 COMMERCE DR STE 200, 200, WOODBURY, MN 55125-4925
(651) 968-5042
(651) 968-5904
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
7341
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063468767
—
MN
01
—
650001460
MEDICARE
MN
01
—
P00326353
RAILROAD MEDICARE
MN
Enumeration date
05/25/2006
Last updated
09/07/2017
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