MEDICARE: JONNAH ANDERSON DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT015534	OH

General Provider Information

NPI Number	:	1073971958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONNAH ANDERSON DPT

Provider Business Mailing Address
First Line	:	8591 CROSSROADS DRIVE
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44514
Country	:	US
Telephone Number	:	330-758-0577
Fax Number	:	330-758-0466

Provider Business Practice Location Address
First Line	:	320 E MARKET ST
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44481-1206
Country	:	US
Telephone Number	:	330-399-2221
Fax Number	:	330-394-0122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2016
Last Update Date	:	04/17/2024

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