Healthcare Provider Details

I. General information

NPI: 1841514429
Provider Name (Legal Business Name): TODD L ANDERSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 GROVE STREET
NEW CANAAN CT
06840
US

IV. Provider business mailing address

1917 ABBOTT RD STE 200
ANCHORAGE AK
99507-3449
US

V. Phone/Fax

Practice location:
  • Phone: 203-966-5752
  • Fax: 203-966-7507
Mailing address:
  • Phone: 907-743-8228
  • Fax: 907-743-8283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008755
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: