Provider Demographics
NPI:1275641243
Name:ANDERSON, REID JEFFRIES (PT)
Entity Type:Individual
Prefix:
First Name:REID
Middle Name:JEFFRIES
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 1:306 HIGH ST # A
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2611
Mailing Address - Country:US
Mailing Address - Phone:413-773-3379
Mailing Address - Fax:413-772-2705
Practice Address - Street 1:306 HIGH ST # A
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2611
Practice Address - Country:US
Practice Address - Phone:413-773-3379
Practice Address - Fax:413-772-2705
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA323978OtherTUFTS
MAY65340OtherBCBS
MA0378909Medicaid
MA36989OtherFALLON
MAY65340OtherBCBS