MEDICARE: JOSIAH ANDERSON DPT

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	PT 25515	CA

General Provider Information

NPI Number	:	1306885413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSIAH ANDERSON DPT

Provider Business Mailing Address
First Line	:	911 MORAGA RD
Second Line	:	#103
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4579
Country	:	US
Telephone Number	:	925-284-3840
Fax Number	:	925-284-3873

Provider Business Practice Location Address
First Line	:	911 MORAGA RD
Second Line	:	#103
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4579
Country	:	US
Telephone Number	:	925-284-3840
Fax Number	:	925-284-3873

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	11/15/2011

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