MEDICARE: SUSAN C ANDERSON

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	172M00000X	Mechanotherapist	7337	CO

General Provider Information

NPI Number	:	1679804074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN C ANDERSON

Provider Business Mailing Address
First Line	:	4103 BOARDWALK DR
Second Line	:	SUITE 100
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5931
Country	:	US
Telephone Number	:	970-204-0400
Fax Number	:	970-377-1082

Provider Business Practice Location Address
First Line	:	4103 BOARDWALK DR
Second Line	:	SUITE 100
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5931
Country	:	US
Telephone Number	:	970-204-0400
Fax Number	:	970-377-1082

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

Provider Enumeration Date	:	01/25/2010
Last Update Date	:	01/25/2010

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Directions to “ SUSAN C ANDERSON ” Practice Location

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