Provider Demographics
NPI:1932869096
Name:ANDERSON, ELIZABETH FAW (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:FAW
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 1:1029 WINKLER MILL RD
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-7603
Mailing Address - Country:US
Mailing Address - Phone:336-816-3610
Mailing Address - Fax:
Practice Address - Street 1:46 BOONE TRL STE B
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3515
Practice Address - Country:US
Practice Address - Phone:336-818-2700
Practice Address - Fax:336-450-1700
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist