Healthcare Provider Details

I. General information

NPI: 1790845188
Provider Name (Legal Business Name): RALPH LAWRENCE ANDERSON M.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HOSPITAL PKWY FL 5
SAN JOSE CA
95119-1106
US

IV. Provider business mailing address

275 HOSPITAL PKWY FL 5
SAN JOSE CA
95119-1106
US

V. Phone/Fax

Practice location:
  • Phone: 408-363-4954
  • Fax:
Mailing address:
  • Phone: 408-363-4954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number20266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: