Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 4206 | AZ |
NPI | 1003034836 |
---|---|
Provider Name | Mr. Michael L Anderes |
First Address | Tucson, AZ 85718-1632 |
Second Address | Tucson, AZ 85711-2602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |