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NPI Code Detail

MEDICARE: MONTAQUE ANN ANDERSON PTA

MEDICARE: MONTAQUE ANN ANDERSON PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant000209WV

General Provider Information

NPI Number : 1053518977
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONTAQUE ANN ANDERSON PTA
Provider Business Mailing Address
First Line : 1808 ROUNDHILL RD
Second Line :
City : CHARLESTON
State : WV
Zip : 25314-1538
Country : US
Telephone Number : 304-419-4189
Fax Number :
Provider Business Practice Location Address
First Line : 6900 COUNTRY CLUB DR
Second Line :
City : HUNTINGTON
State : WV
Zip : 25705-2000
Country : US
Telephone Number : 304-733-1060
Fax Number : 304-733-9284
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2007
Last Update Date : 07/08/2007

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Directions to “ MONTAQUE ANN ANDERSON PTA” Practice Location

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