Basic Information
| Provider Information | |||||||||
| NPI: | 1538207550 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ANDA | ||||||||
| FirstName: | AMBER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 DEERHURST CIR | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805256917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702188505 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4617 W 20TH ST UNIT A | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806343207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703529022 | ||||||||
| FaxNumber: | 9703529048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 06/24/2013 | ||||||||
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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 | 2004021780 | MO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 11-03398 | KS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PTL.0011088 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.