Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 25392 | MD |
N | 2251X0800X | Physical Therapist - Orthopedic | 008333 | CT |
NPI | 1023279080 |
---|---|
Provider Name | Kenneth M Anderson |
First Address | Washington, DC 20011-2730 |
Second Address | Washington, DC 20011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2008 |
Last Update Date | 08/08/2018 |