MEDICARE: MR. JAMES EDWARD ANDERSON PTA

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	225200000X	Physical Therapy Assistant	2037554	TX

General Provider Information

NPI Number	:	1346269909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES EDWARD ANDERSON PTA

Provider Business Mailing Address
First Line	:	PO BOX 300667
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77230-0667
Country	:	US
Telephone Number	:	713-797-6591
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 S LOOP WEST
Second Line	:	#200
City	:	HOUSTON
State	:	TX
Zip	:	77054
Country	:	US
Telephone Number	:	713-797-6106
Fax Number	:

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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