| Doctor Name: | DR. MARIO DONNELL ANDERSON |
| NPI Number: | 1073829826 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | PT010030 |
| Business Practice Address: | 5370 Campbellton Fairburn Rd Suite 530 Fairburn, GA - 302132296 |
| Business Phone Number: | 6786664146 |
| Business Fax Number: | 6786664148 |
| Mailing Address: | 8823 Production Ln, OOLTEWAH |
| State: | TN |
| Postal Code: | 373636511 |
| Phone Number: | 4232387217 |
| Fax Number: | 4232383473 |
| NPI Enumeration Date: | 08/30/2010 |
| NPI Last Update Date: | 03/21/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT010030 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |