Provider Demographics
NPI:1346956554
Name:ANDERSON PHYSICAL THERAPY ETC PC
Entity type:Organization
Organization Name:ANDERSON PHYSICAL THERAPY ETC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASTER
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:814-673-4447
Mailing Address - Street 1:202 UNION ST STE 1
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1166
Mailing Address - Country:US
Mailing Address - Phone:814-670-0534
Mailing Address - Fax:814-670-0653
Practice Address - Street 1:180 N FRANKLIN ST STE F
Practice Address - Street 2:
Practice Address - City:COCHRANTON
Practice Address - State:PA
Practice Address - Zip Code:16314-9706
Practice Address - Country:US
Practice Address - Phone:814-638-0238
Practice Address - Fax:814-638-0007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDERSON PHYSICAL THERAPY ETC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy