MEDICARE: DR. MARCUS 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		FL
2	225100000X	Physical Therapist	PT32314	FL

General Provider Information

NPI Number	:	1598206625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCUS ANDERSON DPT

Provider Business Mailing Address
First Line	:	2172 SE BAYA DR STE 109
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-4921
Country	:	US
Telephone Number	:	407-497-0827
Fax Number	:

Provider Business Practice Location Address
First Line	:	2172 SE BAYA DR STE 102
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-4921
Country	:	US
Telephone Number	:	386-243-0592
Fax Number	:

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

Provider Enumeration Date	:	03/08/2017
Last Update Date	:	08/27/2025

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