Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1513 | ND |
N | 2251P0200X | Physical Therapist - Pediatrics | 8173 | MN |
NPI | 1033374954 |
---|---|
Provider Name | Mrs. Brittany Sue Anderson |
First Address | Fargo, ND 58103-6048 |
Second Address | Fargo, ND 58103-6048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2008 |
Last Update Date | 03/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55279 | (05) | ND |