Individual provider Active NPI

Sherilyn Ann Andersen, PT

  • Physical Therapist
  • Modesto, CA
National Provider Identifier
1790901155
Registry record updated Oct 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT217120 Issued in CA
Practice address
3500 Coffee Rd Ste 3
Modesto, CA 95355-1315
Phone
(209) 549-4626
Fax
(209) 549-4625
NPI assigned
Apr 17, 2007
Last updated
Oct 7, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT217120 CA Primary

Addresses

Primary practice location

3500 Coffee Rd Ste 3
Modesto, CA 95355-1315

Mailing address

4301 N Star Way
Modesto, CA 95356-9262
Phone (209) 342-2349

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100108000308 CA Practitioner - Physical Therapist in Private Practice 8426140351 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Andersen Physical Therapy IncGroup PAC ID 3678520244, 11 clinicians

Practice addresses (Care Compare)

1917 Coffee Rd
Modesto, CA 95355-2704
Phone (209) 549-4626

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT217120CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Andersen Physical Therapy, Inc Physical Therapist CurrentSince Feb 15, 2022 Accepting new patients
Andersen Physical Therapy, Inc. CurrentSince Mar 21, 2007 Accepting new patients

Locations

1917 Coffee Rd
Modesto, CA 95355
Phone (209) 549-4626

3500 Coffee Rd
Ste 3
Modesto, CA 95355
Phone (209) 549-4626

4301 N Star Way
Modesto, CA 95356
Phone (915) 521-2290

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254873600000",
    "number": "1790901155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 N STAR WAY",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569262",
            "telephone_number": "209-342-2349",
            "fax_number": "209-524-4240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 COFFEE RD STE 3",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551315",
            "telephone_number": "209-549-4626",
            "fax_number": "209-549-4625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "SHERILYN",
        "middle_name": "ANN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2009-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT217120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2009; 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.