Provider Demographics
NPI:1922111038
Name:DAMON ANDERSON & ASSOC PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:DAMON ANDERSON & ASSOC PHYSICAL THERAPY, INC
Other - Org Name:DAMON ANDERSON & ASSOCIATES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST & PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:831-917-2468
Mailing Address - Street 1:980 CASS STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940
Mailing Address - Country:US
Mailing Address - Phone:831-375-1135
Mailing Address - Fax:831-375-1520
Practice Address - Street 1:980 CASS STREET
Practice Address - Street 2:SUITE A
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-375-1135
Practice Address - Fax:831-375-1520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17664ZMedicare ID - Type Unspecified