Provider Demographics
NPI:1265797484
Name:ANSON, PATRICK JOHN (MS, ATC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOHN
Last Name:ANSON
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 TEAL DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36870-8049
Mailing Address - Country:US
Mailing Address - Phone:850-319-9443
Mailing Address - Fax:
Practice Address - Street 1:620 TEAL DR
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36870-8049
Practice Address - Country:US
Practice Address - Phone:850-319-9443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer