Healthcare Provider Details

I. General information

NPI: 1891520185
Provider Name (Legal Business Name): ANDERSEN PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 N GOLDEN STATE BLVD
TURLOCK CA
95382-8841
US

IV. Provider business mailing address

PO BOX 576276
MODESTO CA
95357-6276
US

V. Phone/Fax

Practice location:
  • Phone: 209-549-4626
  • Fax: 209-549-4625
Mailing address:
  • Phone: 209-522-3523
  • Fax: 209-549-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN LYLE ANDERSEN
Title or Position: CO-OWNER
Credential: DPT
Phone: 209-549-4626