Provider Demographics
NPI:1386663276
Name:ANDERSON, JOAN H (PT)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:H
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5890
Mailing Address - Fax:740-446-5532
Practice Address - Street 1:88 E MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:OH
Practice Address - Zip Code:45769-9569
Practice Address - Country:US
Practice Address - Phone:740-992-2188
Practice Address - Fax:740-992-5154
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2221036OtherMOLINA MEDICAID
650019668OtherRR MEDICARE
000000217253OtherANTHEM BCBS
1386663276OtherNPI
001714135OtherMOUNTAIN STATE BCBS
WV0156111000Medicaid
WV0156111000Medicaid