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NPI Code Detail

MEDICARE: ANGELA D ANDERSON

MEDICARE: ANGELA D ANDERSON
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
1225200000XPhysical Therapy AssistantTEI000176PA

General Provider Information

NPI Number : 1659506376
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA D ANDERSON
Provider Business Mailing Address
First Line : 80 WHISPERING OAKS RD
Second Line :
City : BELLEVILLE
State : PA
Zip : 17004-9041
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4702 E MAIN ST
Second Line :
City : BELLEVILLE
State : PA
Zip : 17004-9251
Country : US
Telephone Number : 814-506-8212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2009
Last Update Date : 05/26/2009

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