Provider Demographics
NPI:1184734741
Name:ANDERSON, RICHARD
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CLAREMONT DR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-8044
Mailing Address - Country:US
Mailing Address - Phone:254-933-7960
Mailing Address - Fax:
Practice Address - Street 1:3106 S W S YOUNG DR
Practice Address - Street 2:SUITE A 102
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-2000
Practice Address - Country:US
Practice Address - Phone:254-628-8391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2020541OtherLICENSE #