Joel Fordyce Anderson, PT
Individual provider Active NPI Physical Therapist · Shell Lake, WI
NPI 1316905482 · NPPES record last updated Sep 8, 2009
Key facts
- NPI
- 1316905482
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 11290-024 (WI)
- Practice address
- 113 4TH Ave
Shell Lake, WI 54871-0300 - Phone
- (715) 468-7833
- Fax
- (715) 468-7303
- NPI assigned
- May 1, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0530 | SD | MD | Family Medicine Physician |
| 11290-024 | WI | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 0530 | SD | |
| Physical Therapist | 225100000X | 11290-024 | WI | Yes |
Addresses
Primary practice location
113 4TH Ave
Shell Lake, WI 54871-0300
Mailing address
PO Box 300
Shell Lake, WI 54871-0300
Phone (715) 468-7833
Other providers in Shell Lake, WI
All providers in Shell Lake, WI · Physical Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2009. 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.