Provider Demographics
NPI:1396961942
Name:ANDERSON, ERIN (MPT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:NEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:385 BROADWAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-3033
Mailing Address - Country:US
Mailing Address - Phone:781-485-1001
Mailing Address - Fax:781-485-1003
Practice Address - Street 1:385 BROADWAY
Practice Address - Street 2:SUITE 205
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3033
Practice Address - Country:US
Practice Address - Phone:781-485-1001
Practice Address - Fax:781-485-1003
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA162322251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic