Healthcare Provider Details

I. General information

NPI: 1912996968
Provider Name (Legal Business Name): JOHN-HENRY ANDERSON DPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20055 SW PACIFIC HWY SUITE 110
SHERWOOD OR
97140-9294
US

IV. Provider business mailing address

11481 SW HALL BLVD SUITE 201
PORTLAND OR
97223-8403
US

V. Phone/Fax

Practice location:
  • Phone: 503-625-1691
  • Fax: 503-925-1460
Mailing address:
  • Phone: 800-219-8835
  • Fax: 503-639-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60210474
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6672
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number1876
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: