Healthcare Provider Details

I. General information

NPI: 1114901147
Provider Name (Legal Business Name): STEPHEN EDWARD ANDERSON PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 41ST AVE SW TAI WEST SEATTLE PHYSICAL THERAPY STE 100
SEATTLE WA
98116-4597
US

IV. Provider business mailing address

11481 SW HALL BLVD THERAPEUTIC ASSOCIATES INC STE 201
PORTLAND OR
97223-8403
US

V. Phone/Fax

Practice location:
  • Phone: 206-932-8363
  • Fax: 206-932-4973
Mailing address:
  • Phone: 800-219-8835
  • Fax: 503-443-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00002911
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1017
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: