MEDICARE: RICHARD ANDERSON

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
1	225200000X	Physical Therapy Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2020541	OTHER	TX	LICENSE #

General Provider Information

NPI Number	:	1184734741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD ANDERSON

Provider Business Mailing Address
First Line	:	206 CLAREMONT DR
Second Line	:
City	:	BELTON
State	:	TX
Zip	:	76513-8044
Country	:	US
Telephone Number	:	254-933-7960
Fax Number	:

Provider Business Practice Location Address
First Line	:	3106 S W S YOUNG DR
Second Line	:	SUITE A 102
City	:	KILLEEN
State	:	TX
Zip	:	76542-2000
Country	:	US
Telephone Number	:	254-628-8391
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ RICHARD ANDERSON ” Practice Location

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