Individual provider Active NPI

Kenneth Daniel Anders

  • Physical Therapy Assistant
  • Thomasville, GA
National Provider Identifier
1346714540
Registry record updated Jan 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PTA03556 Issued in GA
Practice address
915 Gordon Ave
Thomasville, GA 31792-6614
Phone
(229) 228-2000
NPI assigned
Jan 22, 2019
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)
No

State licenses

LicenseStateTypeSpecialty
PTA03556GAMDPhysical Therapy Assistant

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PTA03556 GA Primary

Addresses

NPPES NPI Registry

Primary practice location

915 Gordon Ave
Thomasville, GA 31792-6614

Mailing address

915 Gordon Ave
Thomasville, GA 31792-6614

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 22, 2019.

{
    "created_epoch": "1548115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548115200000",
    "number": "1346714540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 GORDON AVE",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 GORDON AVE",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926614",
            "telephone_number": "229-228-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERS",
        "first_name": "KENNETH",
        "middle_name": "DANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-22",
        "last_updated": "2019-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA03556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thomasville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; 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.