Active NPI
Joel Fordyce Anderson, PT
- Physical Therapist
- Shell Lake, WI
National Provider Identifier
1316905482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11290-024
- Practice address
- 113 4TH Ave
Shell Lake, WI 54871-0300 - Phone
- (715) 468-7833
- Fax
- (715) 468-7303
- NPI assigned
- May 1, 2006
- Last updated
- Sep 8, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 0530 | SD | |
| Physical Therapist | 225100000X | 11290-024 | WI | Primary |
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
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0530 | SD | MD | Family Medicine Physician |
| 11290-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252368000000",
"number": "1316905482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 300",
"city": "SHELL LAKE",
"state": "WI",
"postal_code": "548710300",
"telephone_number": "715-468-7833",
"fax_number": "715-468-7303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "113 4TH AVE",
"city": "SHELL LAKE",
"state": "WI",
"postal_code": "548710300",
"telephone_number": "715-468-7833",
"fax_number": "715-468-7303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "JOEL",
"middle_name": "FORDYCE",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-01",
"last_updated": "2009-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SD",
"license": "0530",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "11290-024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shell Lake, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.