# ANDERSEN PHYSICAL THERAPY, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ANDERSEN PHYSICAL THERAPY, INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1750068730
- **Legal business name:** ANDERSEN PHYSICAL THERAPY, INC
- **Authorized official:** JONATHAN LYLE ANDERSEN DPT (CO OWNER)
- **Authorized official phone:** (209) 549-4626

## Contact information

- **Practice address:** 8807 THORNTON RD STE M, STOCKTON, CA 95209-1863
- **Practice address phone:** (209) 475-8568
- **Practice address fax:** (209) 475-8582
- **Mailing address:** PO BOX 576276, MODESTO, CA 95357-6276
- **Mailing address phone:** (209) 522-3523
- **Mailing address fax:** (209) 549-4625

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2251H1200X | Hand Physical Therapist | — | NULL | — |
| 2251H1200X | Hand Physical Therapist | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 225XH1200X | Hand Occupational Therapist | — | NULL | Yes |
| 225XH1200X | Hand Occupational Therapist | — | — | Yes |

## Other

- **Enumeration date:** 06/30/2023
- **Last updated:** 06/30/2023