Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 4777580-2401 | UT |
NPI | 1063663540 |
---|---|
Provider Name | Mr. Paul D. Anderson |
First Address | Alpine, UT 84004-5602 |
Second Address | Alpine, UT 84004-5602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2008 |
Last Update Date | 02/10/2008 |