Provider Demographics
NPI:1578557658
Name:ANDERSON, PAUL E (PT OCS)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PT OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 PARK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2290
Mailing Address - Country:US
Mailing Address - Phone:704-323-3611
Mailing Address - Fax:
Practice Address - Street 1:2400 W MALLARD CREEK CHURCH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2324
Practice Address - Country:US
Practice Address - Phone:704-323-2108
Practice Address - Fax:704-323-2199
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2022-12-23
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
NCP6248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0397730041OtherNSC#
0150FOtherBCBS
80160549OtherMEDCOST
0005376395OtherAETNA
26532OtherPARTNERS
26532OtherPARTNERS