Provider Demographics
NPI:1669123436
Name:ANDERSON, ROBERT LEONARD (DPT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEONARD
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:HONDO
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:3605 PRECISION DR APT 267
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-4564
Mailing Address - Country:US
Mailing Address - Phone:970-819-7952
Mailing Address - Fax:
Practice Address - Street 1:1555 MAIN ST UNIT A4
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5999
Practice Address - Country:US
Practice Address - Phone:970-674-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0018146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist