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General NPI Number Information
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NPI Number | 1477733095
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Entity Type | Individual
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Provider Name | ADAM ANDERSEN PT
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Gender | Male
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Dates
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Enumeration Date | 11/12/2007
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 100 E WALTON STREET SUITE 700
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City | CHICAGO
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State | IL
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Zip | 60611-1448
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Country | US
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Telephone | 312-642-3963
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Fax | 312-642-3966
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Provider Business Mailing Address
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Address Line | PO BOX 207
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City | WORTH
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State | IL
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Zip | 60482-0207
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Country | US
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Telephone | 708-403-1155
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Fax | 708-403-1177
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 07013087
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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