Provider Demographics
NPI:1588626931
Name:ANDERSON, ROSS M (MPT)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-5906
Mailing Address - Country:US
Mailing Address - Phone:253-474-7474
Mailing Address - Fax:253-474-7479
Practice Address - Street 1:1407 E 72ND ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-5906
Practice Address - Country:US
Practice Address - Phone:253-474-7474
Practice Address - Fax:253-474-7479
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8337347Medicaid
WA0220349OtherL&I
WAG8875091Medicare PIN