Provider Demographics
NPI:1578756698
Name:ANDERSON, BELINDA SUE (PTA)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:SUE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 SPRINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-8030
Mailing Address - Country:US
Mailing Address - Phone:432-362-1120
Mailing Address - Fax:
Practice Address - Street 1:808 TOWER DR
Practice Address - Street 2:SUITE 7
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4239
Practice Address - Country:US
Practice Address - Phone:432-335-8777
Practice Address - Fax:432-335-8787
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2032092225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant