Provider Demographics
NPI:1689001927
Name:ANDERSON, JOHN BENJAMIN (DPT)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BENJAMIN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 HIGHWAY 54 W STE 210
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4794
Mailing Address - Country:US
Mailing Address - Phone:770-632-2058
Mailing Address - Fax:770-487-6717
Practice Address - Street 1:1975 HIGHWAY 54 W STE 210
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4794
Practice Address - Country:US
Practice Address - Phone:770-632-2058
Practice Address - Fax:770-487-6717
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist