Provider Demographics
NPI:1659555100
Name:ANDERSON, JONATHAN L
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5734 SPOHN DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4116
Mailing Address - Country:US
Mailing Address - Phone:361-884-4452
Mailing Address - Fax:361-882-5414
Practice Address - Street 1:5734 SPOHN DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4116
Practice Address - Country:US
Practice Address - Phone:361-884-4452
Practice Address - Fax:361-882-5414
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist