Provider Demographics
NPI:1205316510
Name:ANDERSON, RENEE M (PHYSICAL THERAPIST A)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 HITE RD.
Mailing Address - Street 2:
Mailing Address - City:HARWICK
Mailing Address - State:PA
Mailing Address - Zip Code:15049
Mailing Address - Country:US
Mailing Address - Phone:724-274-3211
Mailing Address - Fax:
Practice Address - Street 1:657 HITE RD.
Practice Address - Street 2:
Practice Address - City:HARWICK
Practice Address - State:PA
Practice Address - Zip Code:15049
Practice Address - Country:US
Practice Address - Phone:724-274-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1004199225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant