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General NPI Number Information
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NPI Number | 1265630818
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Entity Type | Individual
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Provider Name | STEVEN BLAINE ANDERSON MPT
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Gender | Male
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 05/09/2018
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Provider Practice Location Address
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Address Line | 2671 SW 4TH AVE
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City | ONTARIO
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State | OR
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Zip | 97914-1833
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Country | US
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Telephone | 541-889-2221
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Fax | 541-889-3437
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Provider Business Mailing Address
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Address Line | 740 SYRINGA SPRINGS DR
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City | FRUITLAND
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State | ID
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Zip | 83619-5023
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Country | US
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Telephone | 801-995-1853
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT-5566
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 6588519-2401
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 62625
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License Number State | OR
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