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General NPI Number Information
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NPI Number | 1760956197
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Entity Type | Individual
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Provider Name | JOHN ELMER ANDERSON ATC
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Gender | Male
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 2201 UNIVERSITY DR
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City | LEMONT FURNACE
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State | PA
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Zip | 15456-1025
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Country | US
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Telephone | 724-430-4254
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Fax | 724-430-4135
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Provider Business Mailing Address
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Address Line | 12350 ROTH DR
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City | NORTH HUNTINGDON
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State | PA
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Zip | 15642-2958
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Country | US
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Telephone | 724-771-8096
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Fax | 724-430-4135
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RTO000239
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License Number State | PA
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