Provider Demographics
NPI:1558478107
Name:ANDERSON, ERIC HENRY (PT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:HENRY
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 W CHANDLER BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5225
Mailing Address - Country:US
Mailing Address - Phone:480-821-1997
Mailing Address - Fax:480-821-1887
Practice Address - Street 1:14202 N SCOTTSDALE RD
Practice Address - Street 2:169
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4077
Practice Address - Country:US
Practice Address - Phone:480-607-9200
Practice Address - Fax:480-607-9207
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
AZ7823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT00007654OtherLICENSE #
AZ600262Medicaid
AZ141769Medicare PIN