Provider Demographics
NPI:1972538791
Name:ANDERSEN, BRUCE A (PT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:ANDERSEN
Suffix:
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 1:420 B ST
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-5070
Mailing Address - Country:US
Mailing Address - Phone:530-749-3475
Mailing Address - Fax:530-749-3446
Practice Address - Street 1:420 B ST
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-5070
Practice Address - Country:US
Practice Address - Phone:530-749-3475
Practice Address - Fax:530-749-3446
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0078390Medicaid
CAP00776459OtherRAILROAD MEDICARE
CAPT0078390Medicaid
CAP00776459OtherRAILROAD MEDICARE