Provider Demographics
NPI:1811419351
Name:ANDERSON, DARREN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 S SOUTHEAST BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-7411
Mailing Address - Country:US
Mailing Address - Phone:808-722-1696
Mailing Address - Fax:
Practice Address - Street 1:414 S UNIVERSITY RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5555
Practice Address - Country:US
Practice Address - Phone:509-924-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-15
Last Update Date:2017-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60746791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist