Active NPI
Aidan Anderson
- Physical Therapist
- Kenosha, WI
National Provider Identifier
1861317331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 17921-24
- Practice address
- 3701 80TH St
Kenosha, WI 53142-4950 - Phone
- (262) 697-1730
- NPI assigned
- Aug 12, 2026
- Last updated
- Aug 25, 2026
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 17921-24 | WI | Primary |
Addresses
Primary practice location
3701 80TH St
Kenosha, WI 53142-4950
Mailing address
2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Other names 1
- Dan Anderson
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 |
|---|---|---|---|
| 17921-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1786492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787616000000",
"number": "1861317331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2122 YORK RD STE 300",
"city": "OAK BROOK",
"state": "IL",
"postal_code": "605231925"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3701 80TH ST",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531424950",
"telephone_number": "262-697-1730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "AIDAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-08-12",
"last_updated": "2026-08-25",
"certification_date": "2026-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "17921-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "DAN",
"last_name": "ANDERSON",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.