Provider Demographics
NPI:1548509706
Name:ANDERSON, DAVID RICHARD (DPT)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RICHARD
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W5322 KLEIN ST
Mailing Address - Street 2:
Mailing Address - City:SARONA
Mailing Address - State:WI
Mailing Address - Zip Code:54870-9027
Mailing Address - Country:US
Mailing Address - Phone:651-334-3902
Mailing Address - Fax:
Practice Address - Street 1:510 1ST ST
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-1241
Practice Address - Country:US
Practice Address - Phone:715-635-3466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11567-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist