Basic Information
| Provider Information | |||||||||
| NPI: | 1063522548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | DAWN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6070 AVENIDA ENCINAS | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604440102 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6070 AVENIDA ENCINAS | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604440102 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 03/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT19801 | 01 | CA | LICENSE # | OTHER |