Glenn Douglas Anderson

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

P160071875 Issued in WA

Practice address

909 S 336TH St Ste 100
Federal Way, WA 98003-7394

Phone

(253) 661-5166

NPI assigned

Jun 21, 2024

Last updated

Jun 21, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718928000000",
    "number": "1043054364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37303 34TH AVE S",
            "city": "AUBURN",
            "state": "WA",
            "postal_code": "980018701",
            "telephone_number": "253-592-9189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 S 336TH ST STE 100",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980037394",
            "telephone_number": "253-661-5166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "GLENN",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-21",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "P160071875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Anaya
• Amanda Elizabeth Anderson, LPN
• Angelica Elizabeth Anderson, PT
• Barbara Anne Anderson, REGISTERED NURSE
• Davaughn Anderson
• Haley Anderson, LMP
• Kyle Anderson, LMFT
• Laura Anderson, DPT
• Sharese Anderson, LMP
• Yumi Ando, M.D.

• Physical Therapy Assistant in Federal Way, WA
• Providers in Federal Way, WA by specialty
• Physical Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.