Provider Demographics
NPI:1760956197
Name:ANDERSON, JOHN ELMER (ATC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ELMER
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:ELMER
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:12350 ROTH DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2958
Mailing Address - Country:US
Mailing Address - Phone:724-771-8096
Mailing Address - Fax:724-430-4135
Practice Address - Street 1:2201 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:LEMONT FURNACE
Practice Address - State:PA
Practice Address - Zip Code:15456-1025
Practice Address - Country:US
Practice Address - Phone:724-430-4254
Practice Address - Fax:724-430-4135
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARTO0002392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer