Healthcare Provider Details

I. General information

NPI: 1902923659
Provider Name (Legal Business Name): TERRY DAWN ANDERSON LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 SUMMERS ST
PARKERSBURG WV
26101-6022
US

IV. Provider business mailing address

1490 BLENNERHASSETT HTS
PARKERSBURG WV
26101-8724
US

V. Phone/Fax

Practice location:
  • Phone: 304-428-5573
  • Fax:
Mailing address:
  • Phone: 304-482-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number000645
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: