Provider Demographics
NPI:1598976243
Name:ROSS M. ANDERSON, ANCHOR PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ROSS M. ANDERSON, ANCHOR PHYSICAL THERAPY
Other - Org Name:ANCHOR PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-514-8247
Mailing Address - Street 1:1407 E 72ND ST
Mailing Address - Street 2:SUITE A100
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:
Practice Address - Street 1:1407 E 72ND ST
Practice Address - Street 2:SUITE A100
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA241794OtherL&I
WA7141294Medicaid
WA8861066 AB13912Medicare UPIN