Doctor Name: | MR. PAUL D. ANDERSON |
NPI Number: | 1063663540 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MPT |
License Number: | 4777580-2401 |
Business Practice Address: | 75 W Main Street Ct Ste 100 Alpine, UT - 840045602 |
Business Phone Number: | 8012164298 |
Business Fax Number: | 8012164298 |
Mailing Address: | 75 W Main Street Ct Ste 100, ALPINE |
State: | UT |
Postal Code: | 840045602 |
Phone Number: | 8012164298 |
Fax Number: | 8012164298 |
NPI Enumeration Date: | 10/02/2008 |
NPI Last Update Date: | 10/02/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | 4777580-2401 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |