Provider Demographics
NPI:1891754610
Name:ANDERSON, JAMES H JR (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:H
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W FERTITTA BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4665
Mailing Address - Country:US
Mailing Address - Phone:337-238-9931
Mailing Address - Fax:337-239-0066
Practice Address - Street 1:301 W FERTITTA BLVD STE 4
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4665
Practice Address - Country:US
Practice Address - Phone:337-238-9931
Practice Address - Fax:337-239-0066
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT00223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPT00223OtherPHYSICAL THERAPIST NUMBER