Provider Demographics
NPI:1639235278
Name:ANDERSON PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ANDERSON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTA
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BAKER
Authorized Official - Last Name:HUIET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-231-2874
Mailing Address - Street 1:200 FOX CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1522
Mailing Address - Country:US
Mailing Address - Phone:864-225-3500
Mailing Address - Fax:
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:SUITE 3900
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-231-2874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC622225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty