MEDICARE: MANDY L ANDERSON PT

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	296151	CA

General Provider Information

NPI Number	:	1306951827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDY L ANDERSON PT

Provider Business Mailing Address
First Line	:	1104 DIANTHUS LN
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-6817
Country	:	US
Telephone Number	:	425-679-6056
Fax Number	:

Provider Business Practice Location Address
First Line	:	12600 SE 38TH ST STE 130
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98006-6105
Country	:	US
Telephone Number	:	425-679-6056
Fax Number	:

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	01/03/2019

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