Ethan Anderson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

12383 Issued in AZ

Practice address

7707 W Deer Valley Rd
Suite 100
Peoria, AZ 85382-2101

Phone

(623) 376-9100

Fax

(623) 376-9141

NPI assigned

Aug 12, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Foothills Sports Medicine and Rehabilitation LLCGroup PAC ID 2668457979, 172 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Foothills Sports Medicine & Rehabilitation, LLC

  • Physical Therapist
  • Phoenix, AZ
  • NPI 1558318170

  AZ, Physical Therapist

  Medicare reassignment Care Compare group NPD
• Foothills Sports Medicine & Rehabilitation-Surprise, LLC

  • Physical Therapist
  • Surprise, AZ
  • NPI 1750544623

  AZ, Physical Therapist

  Medicare reassignment NPD
• Foothills Sports Medicine & Rehabilitation, LLC

  • Durable Medical Equipment & Medical Supplies
  • Mesa, AZ
  • NPI 1215648217
  Care Compare group
• Foothills Sports Medicine & Rehabilitation, LLC

  • Durable Medical Equipment & Medical Supplies
  • Tucson, AZ
  • NPI 1538870373
  Care Compare group
• Foothills Sports Medicine & Rehabilitation, LLC

  • Durable Medical Equipment & Medical Supplies
  • Tucson, AZ
  • NPI 1073224267
  NPD

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

{
    "created_epoch": "1470960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470960000000",
    "number": "1063966554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15410 S MOUNTAIN PKWY",
            "address_2": "SUITE 112",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850446691",
            "telephone_number": "480-706-1161",
            "fax_number": "480-706-7997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7707 W DEER VALLEY RD",
            "address_2": "SUITE 100",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853822101",
            "telephone_number": "623-376-9100",
            "fax_number": "623-376-9141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "ETHAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-12",
        "last_updated": "2016-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "12383",
            "primary": true
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel C Anaya, LMT
• Devney Nicole Anaya, SLPA
• Lucindy Anderson-Brown
• Beth Anderson, BSN, RN
• Darren Anderson, DMD
• Fordyce W Anderson, PT
• Kanesha Anderson
• Matthew R Anderson, M.D.
• Andrew Lawson Counseling LLC
• Alicia J Andrews, NP

• All providers in Peoria, AZ
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.