| Doctor Name: | MR. JASON WILLIAM ANDERSON |
| NPI Number: | 1639319924 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 28877 |
| Business Practice Address: | 1640 Newport Blvd Suite 220 Costa Mesa, CA - 926273786 |
| Business Phone Number: | 9496504362 |
| Business Fax Number: | |
| Mailing Address: | 4704 Seashore Dr, Apt B NEWPORT BEACH |
| State: | CA |
| Postal Code: | 926632524 |
| Phone Number: | 4015954076 |
| Fax Number: | |
| NPI Enumeration Date: | 02/25/2009 |
| NPI Last Update Date: | 02/25/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 28877 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| 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 |