Basic Information
| Provider Information | |||||||||
| NPI: | 1235281940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIERCE | ||||||||
| FirstName: | ANJA | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | PT, LMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 FISHERS STATION DR | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | VICTOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145649744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859247207 | ||||||||
| FaxNumber: | 5859247049 | ||||||||
| Practice Location | |||||||||
| Address1: | 590 FISHERS STATION DR | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | VICTOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145649744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859247207 | ||||||||
| FaxNumber: | 5859247049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 09/03/2009 | ||||||||
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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 | 021711 1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.