Doctor Name: | KENNETH M ANDERSON |
NPI Number: | 1023279080 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | R.P.T. |
License Number: | 008333 |
Business Practice Address: | 196 Parkway S Ste 202 Waterford, CT - 063851234 |
Business Phone Number: | 8604470417 |
Business Fax Number: | 8604472193 |
Mailing Address: | 6 Rose Ln, EAST LYME |
State: | CT |
Postal Code: | 063331648 |
Phone Number: | 8604470417 |
Fax Number: | 8604472193 |
NPI Enumeration Date: | 06/23/2008 |
NPI Last Update Date: | 06/23/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | 008333 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |