Jon Richard Anderson, PTA
Specialist/Technologist, Other in Fort Benning, GA. Individual provider (NPI-1).
NPI number1962371963
StatusActive
Last updated in NPPESOct 30, 2025
Details
- NPI
- 1962371963
- Entity type
- Individual (NPI-1)
- Name
- Mr. Jon Richard Anderson
- Credential
- PTA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 30, 2025
- Certification date
- Oct 30, 2025
- Last updated
- Oct 30, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 246Z00000X | Specialist/Technologist, Other | – | GA | Yes |
Practice location
6998 Old Cusseta RdFort Benning, GA 31905-5431
Phone 706-626-1598
Mailing address
6998 Old Cusseta RdFort Benning, GA 31905-5431
Phone 706-626-1598
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