Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PTH9525 | AL |
N | 2251S0007X | Physical Therapist - Sports | PTH9525 | AL |
NPI | 1255980181 |
---|---|
Provider Name | Shelley Anne Anderson |
First Address | Birmingham, AL 35242-8135 |
Second Address | Birmingham, AL 35242-8135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2019 |
Last Update Date | 23/08/2021 |