Provider Demographics
NPI:1225518962
Name:ANDERSON, KARA ELLEN
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:ELLEN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13156 RANCH ROAD 1631
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5735
Mailing Address - Country:US
Mailing Address - Phone:830-685-3508
Mailing Address - Fax:
Practice Address - Street 1:1117 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5003
Practice Address - Country:US
Practice Address - Phone:830-997-4364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2020533225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2020533OtherPHYSICAL THERAPIST ASSISTANT