Provider Demographics
NPI:1477292977
Name:ANDERSON, DANI (PT)
Entity Type:Individual
Prefix:
First Name:DANI
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6664 HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:IA
Mailing Address - Zip Code:50211-9027
Mailing Address - Country:US
Mailing Address - Phone:515-724-3041
Mailing Address - Fax:
Practice Address - Street 1:1301 PENNSYLVANIA AVE STE 213
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2365
Practice Address - Country:US
Practice Address - Phone:515-224-1414
Practice Address - Fax:515-224-1414
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist