Provider Demographics
NPI:1265598619
Name:ANDERSEN, JANICE IONE (PT)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:IONE
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13629 W CAMINO DEL SOL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-1405
Mailing Address - Country:US
Mailing Address - Phone:928-343-7828
Mailing Address - Fax:
Practice Address - Street 1:10503 W THUNDERBIRD BLVD STE 263A
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3048
Practice Address - Country:US
Practice Address - Phone:623-888-3370
Practice Address - Fax:480-795-6158
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6970225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ115677Medicare PIN