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General NPI Number Information
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NPI Number | 1306148481
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Entity Type | Individual
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Provider Name | TRACI LEIGH ANDERSEN DPT
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Gender | Female
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 1611 NW 12TH AVE REHABILITATION HOSPITAL ROOM 146
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City | MIAMI
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State | FL
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Zip | 33136-1005
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Country | US
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Telephone | 305-585-6334
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Fax |
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Provider Business Mailing Address
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Address Line | 1865 BRICKELL AVE APARTMENT A506
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City | MIAMI
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State | FL
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Zip | 33129-1621
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Country | US
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Telephone | 757-869-1938
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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 | PT 25730
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License Number State | FL
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