MEDICARE: REID JEFFRIES ANDERSON P.T.

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	225100000X	Physical Therapist	4764	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	323978	OTHER	MA	TUFTS
2	Y65340	OTHER	MA	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	36989	OTHER	MA	FALLON

General Provider Information

NPI Number	:	1275641243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REID JEFFRIES ANDERSON P.T.

Provider Business Mailing Address
First Line	:	306 HIGH ST # A
Second Line	:
City	:	GREENFIELD
State	:	MA
Zip	:	01301-2611
Country	:	US
Telephone Number	:	413-773-3379
Fax Number	:	413-772-2705

Provider Business Practice Location Address
First Line	:	306 HIGH ST # A
Second Line	:
City	:	GREENFIELD
State	:	MA
Zip	:	01301-2611
Country	:	US
Telephone Number	:	413-773-3379
Fax Number	:	413-772-2705

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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