1891754610 NPI number — MR. JAMES H ANDERSON JR. PT

Table of content: MR. JAMES H ANDERSON JR. PT (NPI 1891754610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891754610 NPI number — MR. JAMES H ANDERSON JR. PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
JAMES
Provider Middle Name:
H
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891754610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 W FERTITTA BLVD STE 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEESVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71446-4665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-238-9931
Provider Business Mailing Address Fax Number:
337-239-0066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 W FERTITTA BLVD STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEESVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71446-4665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-238-9931
Provider Business Practice Location Address Fax Number:
337-239-0066
Provider Enumeration Date:
03/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00223 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT00223 . This is a "PHYSICAL THERAPIST NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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