Provider Demographics
NPI:1467860650
Name:ANDERSON, AMBER (DPT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 S KINNICKINNIC AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-1364
Mailing Address - Country:US
Mailing Address - Phone:414-744-0707
Mailing Address - Fax:414-744-0708
Practice Address - Street 1:2121 S KINNICKINNIC AVE
Practice Address - Street 2:STE 3
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-1364
Practice Address - Country:US
Practice Address - Phone:414-744-0707
Practice Address - Fax:414-744-0708
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist