Provider Demographics
NPI:1609183227
Name:ANDERSON, MICHAEL PAUL (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PAUL
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 1:176 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3126
Mailing Address - Country:US
Mailing Address - Phone:978-452-9252
Mailing Address - Fax:979-970-0271
Practice Address - Street 1:176 WALKER ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3126
Practice Address - Country:US
Practice Address - Phone:978-452-9252
Practice Address - Fax:979-970-0271
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA191492251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic