Provider Demographics
NPI:1649310293
Name:ANDERSON, JOEL W (DPT,MOMT,PHD,FAAOMPT)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPT,MOMT,PHD,FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24719 59TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-9782
Mailing Address - Country:US
Mailing Address - Phone:360-588-4145
Mailing Address - Fax:425-962-9449
Practice Address - Street 1:24719 59TH AVE NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-9782
Practice Address - Country:US
Practice Address - Phone:425-760-8034
Practice Address - Fax:425-962-9449
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0412622OtherSTATE OF WA LABOR AND INDUSTRIES
WA8351199Medicaid