Individual
MATTHEW RAY ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
23770 HOSPITAL ST, CASSOPOLIS, MI 49031-9699
(269) 445-3801
Mailing address
52465 SANTA MONICA DR, GRANGER, IN 46530-9652
(574) 323-3030
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502002547
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5502002547
PTA LICENSE #
MI
Enumeration date
07/12/2021
Last updated
07/12/2021
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