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General NPI Number Information
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NPI Number | 1194817767
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Entity Type | Individual
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Provider Name | ROGER CHARLES ANDERSON JR. P.T.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 21700 NORTHWESTERN HWY STE 900
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4906
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Country | US
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Telephone | 248-556-9106
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Fax |
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Provider Business Mailing Address
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Address Line | 38250 FAIRWAY COURT #70
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038
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Country | US
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Telephone | 586-263-3770
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501004487
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License Number State | MI
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