Organization
ANDERSEN PHYSICAL THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYLE MELVIN ANDERSEN PT (CO OWNER)
(209) 549-4626
Entity
Organization
Contact information
Practice address
1917 COFFEE RD, MODESTO, CA 95355-2704
(209) 549-4626
(209) 549-4625
Mailing address
PO BOX 576276, MODESTO, CA 95357-6276
(209) 549-4626
(209) 549-4625
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
0134075
CA
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
YYY48495Y
BLUE SHIELD
CA
Enumeration date
11/03/2005
Last updated
04/17/2017
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