Provider Demographics
NPI:1225132228
Name:ANDERSON, WILLIAM E (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DELTA
Mailing Address - State:OH
Mailing Address - Zip Code:43515-1462
Mailing Address - Country:US
Mailing Address - Phone:419-822-4100
Mailing Address - Fax:419-822-0334
Practice Address - Street 1:816 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:DELTA
Practice Address - State:OH
Practice Address - Zip Code:43515-1462
Practice Address - Country:US
Practice Address - Phone:419-822-4100
Practice Address - Fax:419-822-0334
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 9088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH24671740213Medicaid
OH24671740213Medicaid