MEDICARE: GAYLE S ANDERSEN 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	171W00000X	Contractor	2305002349	VA

General Provider Information

NPI Number	:	1770709073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLE S ANDERSEN PT

Provider Business Mailing Address
First Line	:	4667 BURNLEY BRANCH LN
Second Line	:
City	:	BARBOURSVILLE
State	:	VA
Zip	:	22923-1810
Country	:	US
Telephone Number	:	434-973-5792
Fax Number	:	434-973-5792

Provider Business Practice Location Address
First Line	:	4667 BURNLEY BRANCH LN
Second Line	:
City	:	BARBOURSVILLE
State	:	VA
Zip	:	22923-1810
Country	:	US
Telephone Number	:	434-973-5792
Fax Number	:	434-973-5792

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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