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NPI Code Detail

MEDICARE: DR. CODI JO ANDERSEN PT, DPT

MEDICARE: DR. CODI JO ANDERSEN PT, 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
1225100000XPhysical Therapist40731CA

General Provider Information

NPI Number : 1790623544
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CODI JO ANDERSEN PT, DPT
Provider Business Mailing Address
First Line : 17800 US HIGHWAY 18
Second Line :
City : APPLE VALLEY
State : CA
Zip : 92307-1221
Country : US
Telephone Number : 217-299-0536
Fax Number :
Provider Business Practice Location Address
First Line : 17800 US HIGHWAY 18
Second Line :
City : APPLE VALLEY
State : CA
Zip : 92307-1221
Country : US
Telephone Number : 760-646-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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