Individual provider Active NPI

Justin Keith Sanderson, PT, DPT

  • Physical Therapist
  • Jber, AK
National Provider Identifier
1487360954
Registry record updated Nov 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
30975 Issued in AZ
Practice address
5955 Zeamer Ave
Jber, AK 99506-3702
Phone
(480) 567-2987
Fax
(480) 347-0240
NPI assigned
Jan 26, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 30975 AZ Primary

Addresses

Primary practice location

5955 Zeamer Ave
Jber, AK 99506-3702

Mailing address

5955 Zeamer Ave
Jber, AK 99506-3702
Phone (907) 580-1701

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230320002039 AZ Practitioner - Physical Therapist in Private Practice 6103290879 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30975AZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Inbalance PT LLC Physical Therapist CurrentSince Nov 30, 2022 Accepting new patients

Locations

36397 N Gantzel Rd
San Tan Valley, AZ 85140
Phone (480) 567-2987

36397 N Gantzel Rd
Ste 102
San Tan Vly, AZ 85140
Phone (480) 567-2231

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764288000000",
    "number": "1487360954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5955 ZEAMER AVE",
            "city": "JBER",
            "state": "AK",
            "postal_code": "995063702",
            "telephone_number": "907-580-1701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5955 ZEAMER AVE",
            "city": "JBER",
            "state": "AK",
            "postal_code": "995063702",
            "telephone_number": "480-567-2987",
            "fax_number": "480-347-0240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERSON",
        "first_name": "JUSTIN",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-26",
        "last_updated": "2025-11-28",
        "certification_date": "2025-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "30975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jber, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.