Provider Demographics
NPI:1487647376
Name:ANDERSON PHYSICAL THERAPY ETC PC
Entity Type:Organization
Organization Name:ANDERSON PHYSICAL THERAPY ETC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LHUILLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-670-0534
Mailing Address - Street 1:202 UNION ST STE 1
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1166
Mailing Address - Country:US
Mailing Address - Phone:814-670-0534
Mailing Address - Fax:814-670-0653
Practice Address - Street 1:3232 STATE ROUTE 257
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-2434
Practice Address - Country:US
Practice Address - Phone:814-676-6675
Practice Address - Fax:814-676-6886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA030640OtherMEDICARE PTAN
PA1007575500027Medicaid
PA839944OtherHIGHMARK
PACG7782OtherRAILROAD
PACG7783OtherRAILROAD
PA117852OtherHEALTH AMERICA