Healthcare Provider Details

I. General information

NPI: 1346956554
Provider Name (Legal Business Name): ANDERSON PHYSICAL THERAPY ETC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N FRANKLIN ST STE F
COCHRANTON PA
16314-9706
US

IV. Provider business mailing address

202 UNION ST STE 1
TITUSVILLE PA
16354-1166
US

V. Phone/Fax

Practice location:
  • Phone: 814-638-0238
  • Fax: 814-638-0007
Mailing address:
  • Phone: 814-670-0534
  • Fax: 814-670-0653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIRK A MASTER
Title or Position: DIRECTOR
Credential: PTA
Phone: 814-673-4447