MEDICARE: DAVID ODELL 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	4296	SC
2	225100000X	Physical Therapist	23390	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336293133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ODELL ANDERSON PT

Provider Business Mailing Address
First Line	:	1439 ARTIMINO LN
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-1111
Country	:	US
Telephone Number	:	843-834-4622
Fax Number	:

Provider Business Practice Location Address
First Line	:	1439 ARTIMINO LN
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-1111
Country	:	US
Telephone Number	:	561-797-7987
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	01/10/2013

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Directions to “ DAVID ODELL ANDERSON PT” Practice Location

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