Provider Demographics
NPI:1396395653
Name:ANDERSON, ERIC JOSEPH (PT,DPT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JOSEPH
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-2722
Mailing Address - Country:US
Mailing Address - Phone:718-689-3662
Mailing Address - Fax:
Practice Address - Street 1:2350 W OREGON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4122
Practice Address - Country:US
Practice Address - Phone:215-336-6630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044937225100000X
PA029971225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist