MEDICARE: KRISTIN MICHELE ANDERSON 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
1	225100000X	Physical Therapist	40374	CA
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1811337082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MICHELE ANDERSON DPT

Provider Business Mailing Address
First Line	:	4326 CAHUENGA BLVD
Second Line	:	APT 7
City	:	TOLUCA LAKE
State	:	CA
Zip	:	91602-2765
Country	:	US
Telephone Number	:	661-877-7389
Fax Number	:

Provider Business Practice Location Address
First Line	:	488 S SAN VICENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4107
Country	:	US
Telephone Number	:	323-655-9055
Fax Number	:

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

Provider Enumeration Date	:	07/02/2013
Last Update Date	:	01/14/2015

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