Provider Demographics
NPI:1831108448
Name:ANDERSON, FAITH ANGELI (PT)
Entity Type:Individual
Prefix:MRS
First Name:FAITH
Middle Name:ANGELI
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:RAYMONDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78580-0092
Mailing Address - Country:US
Mailing Address - Phone:956-689-5301
Mailing Address - Fax:956-689-2004
Practice Address - Street 1:100 N HWY 77 STE I
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-4010
Practice Address - Country:US
Practice Address - Phone:956-689-5301
Practice Address - Fax:956-689-2004
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1085371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T6371 BC/BSOtherPHYSICAL THERAPIST