Provider Demographics
NPI:1386620938
Name:PEDERSEN, ANNE HUI (PT)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:HUI
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 KNOX ST
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1304
Mailing Address - Country:US
Mailing Address - Phone:606-546-6027
Mailing Address - Fax:606-546-2084
Practice Address - Street 1:602 KNOX ST
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1304
Practice Address - Country:US
Practice Address - Phone:606-546-6027
Practice Address - Fax:606-546-2084
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY87900551Medicaid
KYP00179902OtherRR MEDICARE
KY000000333713OtherBC
KY87900551Medicaid
KYP00179902OtherRR MEDICARE