Individual
MRS. ELLISON RENEE SANDERS
Active
Individual
MRS. ELLISON RENEE SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT-2061
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010164610
REGENCE BLUE SHIELD
—
05
—
807908300
—
ID
01
—
TD688
BLUE CROSS OF IDAHO
—
Enumeration date
10/15/2007
Last updated
01/30/2012
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