MEDICARE: AMY 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	PT01871	RI

General Provider Information

NPI Number	:	1740219120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY ANDERSON PT

Provider Business Mailing Address
First Line	:	660 COMMONWEALTH AVE
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-2707
Country	:	US
Telephone Number	:	401-691-4729
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 CATAMORE BLVD
Second Line	:
City	:	EAST PROVIDENCE
State	:	RI
Zip	:	02914-1203
Country	:	US
Telephone Number	:	401-434-7784
Fax Number	:

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	03/10/2015

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