Provider Demographics
NPI:1396004883
Name:ANDERSON PHYSICAL THERAPY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ANDERSON PHYSICAL THERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:678-761-6866
Mailing Address - Street 1:5775 OLD WINDER HWY
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-1603
Mailing Address - Country:US
Mailing Address - Phone:678-866-4104
Mailing Address - Fax:678-828-5887
Practice Address - Street 1:5775 OLD WINDER HWY
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-1603
Practice Address - Country:US
Practice Address - Phone:678-866-4104
Practice Address - Fax:678-828-5887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty