Provider Demographics
NPI:1114983640
Name:ABA PHYSICAL THERAPY ASSOCIATES PC
Entity Type:Organization
Organization Name:ABA PHYSICAL THERAPY ASSOCIATES PC
Other - Org Name:STEVEN H. ANDERSON DBA: ABA PHYSICAL THERAPY ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:650-558-0247
Mailing Address - Street 1:1670 S AMPHLETT BLVD # 123
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2512
Mailing Address - Country:US
Mailing Address - Phone:650-558-0247
Mailing Address - Fax:650-558-1735
Practice Address - Street 1:1670 S AMPHLETT BLVD # 123
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2512
Practice Address - Country:US
Practice Address - Phone:650-558-0247
Practice Address - Fax:650-558-1735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
CA225100000X
CAPT010010225100000X
CAPT9998225100000X
CAPT3088225100000X
CAPT9671225100000X
CAPT9940225100000X
CAPT9657225100000X
CAPT24571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ197982Medicare UPIN
ZZZ197982Medicare UPIN
CAZZZ197982Medicare PIN