Provider Demographics
NPI:1992278279
Name:ANDERSON, DAVID MICHAEL (PTA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 WINTE STREER
Mailing Address - Street 2:ATTN: PRO SPORTS THERAPY
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1433
Mailing Address - Country:US
Mailing Address - Phone:781-487-9944
Mailing Address - Fax:781-487-9966
Practice Address - Street 1:334 LITTLETON RD
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-4123
Practice Address - Country:US
Practice Address - Phone:978-392-0483
Practice Address - Fax:978-392-0947
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9547225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant