Individual
ERIC SANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2525 KANEVILLE RD, GENEVA, IL 60134-2578
(630) 584-1411
(630) 513-2630
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070019338
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070019338
STATE OF ILLINOIS
IL
01
—
P01226975
MEDICARE RAILROAD
IL
Enumeration date
08/10/2012
Last updated
09/30/2014
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