MEDICARE: KENDALL ANASTASIA 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
2	225100000X	Physical Therapist	12533	SC

General Provider Information

NPI Number	:	1619700812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL ANASTASIA ANDERSON DPT

Provider Business Mailing Address
First Line	:	1787 S LAKE DR STE H
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-6736
Country	:	US
Telephone Number	:	803-957-0404
Fax Number	:	803-957-0468

Provider Business Practice Location Address
First Line	:	1787 S LAKE DR STE H
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-6736
Country	:	US
Telephone Number	:	803-957-0404
Fax Number	:	803-957-0468

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

Provider Enumeration Date	:	08/22/2024
Last Update Date	:	08/27/2024

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