MEDICARE: DR. INGRID ANDERSON DPT, PT, OCS

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	PT010150	GA

General Provider Information

NPI Number	:	1235431396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INGRID ANDERSON DPT, PT, OCS

Provider Business Mailing Address
First Line	:	495 MORELAND AVE SE STE B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-1552
Country	:	US
Telephone Number	:	404-883-2304
Fax Number	:	404-393-3270

Provider Business Practice Location Address
First Line	:	495 MORELAND AVE SE STE B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-1552
Country	:	US
Telephone Number	:	404-883-2304
Fax Number	:	404-393-3270

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

Provider Enumeration Date	:	11/23/2010
Last Update Date	:	07/07/2021

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