Provider Demographics
NPI:1265616916
Name:ANDERSON, MICHELLE P (DPT)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:P
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NETCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07857
Mailing Address - Country:US
Mailing Address - Phone:973-448-1800
Mailing Address - Fax:973-448-9955
Practice Address - Street 1:40 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NETCONG
Practice Address - State:NJ
Practice Address - Zip Code:07857
Practice Address - Country:US
Practice Address - Phone:973-448-1800
Practice Address - Fax:973-448-9955
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01241300225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071361Medicare PIN