Healthcare Provider Details

I. General information

NPI: 1124570767
Provider Name (Legal Business Name): MICHAEL BRENTON ANDERSON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 07/11/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 A DAWES LN E
MOBILE AL
36619-9029
US

IV. Provider business mailing address

4850 A DAWES LN E
MOBILE AL
36619-9029
US

V. Phone/Fax

Practice location:
  • Phone: 251-243-2676
  • Fax: 251-244-3262
Mailing address:
  • Phone: 251-243-2676
  • Fax: 251-244-3262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH8121
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: