Healthcare Provider Details

I. General information

NPI: 1740886597
Provider Name (Legal Business Name): JENNIFER ANDERS LMT, PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 N PERRY ST STE 100
OTTAWA OH
45875-1164
US

IV. Provider business mailing address

1880 N PERRY ST STE 100
OTTAWA OH
45875-1164
US

V. Phone/Fax

Practice location:
  • Phone: 419-523-9003
  • Fax: 419-523-9143
Mailing address:
  • Phone: 419-523-9003
  • Fax: 419-523-9143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA012637
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.020481
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: