Provider Demographics
NPI:1508046095
Name:ANDERSEN, BETTINA L (PT)
Entity Type:Individual
Prefix:
First Name:BETTINA
Middle Name:L
Last Name:ANDERSEN
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 1:5690 THREE NOTCHED RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-3172
Mailing Address - Country:US
Mailing Address - Phone:434-823-7628
Mailing Address - Fax:
Practice Address - Street 1:5690 THREE NOTCHED RD
Practice Address - Street 2:SUITE 107
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-3172
Practice Address - Country:US
Practice Address - Phone:434-823-7628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA015581P09Medicare PIN