Basic Information
| Provider Information | |||||||||
| NPI: | 1164710349 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | JESSE | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3809 WEST CHESTER PIKE | ||||||||
| Address2: | STE 150 | ||||||||
| City: | NEWTOWN SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190730259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103595640 | ||||||||
| FaxNumber: | 6103591519 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 LAWRENCE RD STE 900 | ||||||||
| Address2: | |||||||||
| City: | BROOMALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190083301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104498400 | ||||||||
| FaxNumber: | 6104496392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT021478 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.