Amy Southerland Anderson, PT
Individual provider Active NPI Physical Therapist · Crestview, FL
NPI 1053733188 · NPPES record last updated Jan 8, 2014
Key facts
- NPI
- 1053733188
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 22361 (FL)
- Practice address
- 4432 Goldfinch Way
Crestview, FL 32539-8716 - Phone
- (850) 603-0317
- NPI assigned
- Jan 8, 2014
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22361 | FL | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 22361 | FL | Yes |
Addresses
Primary practice location
4432 Goldfinch Way
Crestview, FL 32539-8716
Mailing address
4432 Goldfinch Way
Crestview, FL 32539-8716
Phone (850) 603-0317
Other providers in Crestview, FL
- Alternative Living Inc.
- Alternative Living, Inc.
- Always Hope Developmental Services
- Amedisys Florida, LLC
- Naana W Anakwah
- Cristina Faith Anderson
- Kallie Anderson
- Micah Anderson
- Misti D Anderson
- Thomas Randall Anderson
All providers in Crestview, FL · Physical Therapist in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.