Healthcare Provider Details

I. General information

NPI: 1235071069
Provider Name (Legal Business Name): ANDERSYN KRISTI BURSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E LUCAS ST
KNOB NOSTER MO
65336-1134
US

IV. Provider business mailing address

106 E LUCAS ST
KNOB NOSTER MO
65336-1134
US

V. Phone/Fax

Practice location:
  • Phone: 660-563-9800
  • Fax: 660-563-9801
Mailing address:
  • Phone: 660-563-9800
  • Fax: 660-563-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2023043105
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: