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General NPI Number Information
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NPI Number | 1730926205
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Entity Type | Individual
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Provider Name | TAVIA MARIE ANDERSON DPT
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Gender | Female
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Dates
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Enumeration Date | 07/11/2024
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 2000 E LAYTON AVE STE 160
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City | ST FRANCIS
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State | WI
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Zip | 53235-6054
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Country | US
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Telephone | 414-747-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 11011 W NORTH AVE APT 100
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City | MILWAUKEE
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State | WI
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Zip | 53226-2275
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Country | US
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Telephone | 920-676-4867
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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 | 16868-24
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License Number State | WI
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