MEDICARE: ANDREA ANDERSON PTA

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	225200000X	Physical Therapy Assistant	1171	NH

General Provider Information

NPI Number	:	1811391923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA ANDERSON PTA

Provider Business Mailing Address
First Line	:	13 CHURCH ST
Second Line	:
City	:	DEERFIELD
State	:	NH
Zip	:	03037-1425
Country	:	US
Telephone Number	:	337-378-7778
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 CHURCH ST
Second Line	:
City	:	DEERFIELD
State	:	NH
Zip	:	03037-1425
Country	:	US
Telephone Number	:	337-378-7778
Fax Number	:

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

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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Directions to “ ANDREA ANDERSON PTA” Practice Location

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