Provider Demographics
NPI:1942400718
Name:ANDERSON, TODD RITCHIE (DPT, MPT, ATC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:RITCHIE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPT, MPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-2203
Mailing Address - Country:US
Mailing Address - Phone:208-785-0628
Mailing Address - Fax:208-785-8667
Practice Address - Street 1:180 N BROADWAY
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-2203
Practice Address - Country:US
Practice Address - Phone:208-785-0628
Practice Address - Fax:208-785-8667
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2016-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1288225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic