Healthcare Provider Details

I. General information

NPI: 1255980181
Provider Name (Legal Business Name): SHELLEY ANNE ANDERSON PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 RESOURCE CENTER PKWY STE 107
BIRMINGHAM AL
35242-8135
US

IV. Provider business mailing address

157 RESOURCE CENTER PKWY STE 107
BIRMINGHAM AL
35242-8135
US

V. Phone/Fax

Practice location:
  • Phone: 229-402-3338
  • Fax: 205-453-4603
Mailing address:
  • Phone: 229-402-3338
  • Fax: 205-453-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPTH9525
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH9525
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: