MEDICARE: HEIDI LYNNE ANDERS 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
1	2251X0800X	Orthopedic Physical Therapist	298899	CA

General Provider Information

NPI Number	:	1992312086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI LYNNE ANDERS PT, DPT

Provider Business Mailing Address
First Line	:	5805 W 8TH ST APT 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4576
Country	:	US
Telephone Number	:	208-596-0805
Fax Number	:

Provider Business Practice Location Address
First Line	:	5805 W 8TH ST APT 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4576
Country	:	US
Telephone Number	:	208-596-0805
Fax Number	:

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

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	01/21/2022

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