MEDICARE: MS. JANE 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	784	NM

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	:	1669515425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANE ANDERSON PT

Provider Business Mailing Address
First Line	:	3109 CALLE DE ALAMO NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-3139
Country	:	US
Telephone Number	:	505-345-7612
Fax Number	:	505-341-0176

Provider Business Practice Location Address
First Line	:	3109 CALLE DE ALAMO NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-3139
Country	:	US
Telephone Number	:	505-345-7612
Fax Number	:	505-341-0176

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/09/2007

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Directions to “ MS. JANE ANDERSON PT” Practice Location

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