Provider Demographics
NPI:1669645487
Name:ANDERSON, ORA LEE (LPT)
Entity type:Individual
Prefix:MS
First Name:ORA
Middle Name:LEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 S 14TH AVE UNIT 47
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6287
Mailing Address - Country:US
Mailing Address - Phone:727-488-7344
Mailing Address - Fax:
Practice Address - Street 1:2851 S AVENUE B # 2402
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7726
Practice Address - Country:US
Practice Address - Phone:928-782-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-13
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13967225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPT-010906OtherPHYSICAL THERAPY
FLPT13967OtherSTATE OF FLORIDA