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NPI Code Detail

MEDICARE: MRS. DIANE LEE ANDERSON RPT

MEDICARE: MRS. DIANE LEE ANDERSON RPT
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
1225100000XPhysical TherapistPT000341EPA

General Provider Information

NPI Number : 1306027222
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DIANE LEE ANDERSON RPT
Provider Business Mailing Address
First Line : 106 HILLCREST DR S
Second Line :
City : MACUNGIE
State : PA
Zip : 18062-1608
Country : US
Telephone Number : 610-730-4196
Fax Number :
Provider Business Practice Location Address
First Line : 305 CHERRY ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19106-1803
Country : US
Telephone Number : 800-974-6383
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2007
Last Update Date : 11/19/2007

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Directions to “ MRS. DIANE LEE ANDERSON RPT” Practice Location

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