Provider Demographics
NPI:1306885413
Name:ANDERSON, JOSIAH (DPT)
Entity type:Individual
Prefix:
First Name:JOSIAH
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 MORAGA RD
Mailing Address - Street 2:#103
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4579
Mailing Address - Country:US
Mailing Address - Phone:925-284-3840
Mailing Address - Fax:925-284-3873
Practice Address - Street 1:911 MORAGA RD
Practice Address - Street 2:#103
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4579
Practice Address - Country:US
Practice Address - Phone:925-284-3840
Practice Address - Fax:925-284-3873
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 25515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAP009YMedicare PIN