Healthcare Provider Details

I. General information

NPI: 1104740992
Provider Name (Legal Business Name): CAROL ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 LAKEVIEW DR
NOBLESVILLE IN
46060-1210
US

IV. Provider business mailing address

16706 MAINES VALLEY DR
NOBLESVILLE IN
46062-6816
US

V. Phone/Fax

Practice location:
  • Phone: 317-776-1061
  • Fax:
Mailing address:
  • Phone: 423-413-1351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06005871A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: