Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 11141 | AZ |
NPI | 1003216730 |
---|---|
Provider Name | Christopher Samuel Anderson |
First Address | Tempe, AZ 85283-1545 |
Second Address | Mesa, AZ 85202-4752 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2014 |
Last Update Date | 09/03/2020 |