Individual ProviderDean Charles AndersonPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address2951 Montvale Drive, Suite A, Springfield, IL 62704(217) 698-4055(217) 391-4662PECOS EnrollmentBased on the most recent information from CMS, provider Dean Charles Anderson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1780708958Provider TypeIndividualFull NameAnderson, Dean CharlesTitleMr.CredentialMA, PT, CERT. MDTGenderMaleSole ProprietorNoEnumeration Date3/16/2007Last Updated7/8/2007Contact InformationPractice LocationPractice Address2951 Montvale Drive, Suite A, Springfield, IL 62704Phone(217) 698-4055Fax(217) 698-4056Mailing LocationMailing Address2300 Hurstbourne Ln, Chatham, IL 62629-8677Phone(217) 391-4662FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense070.011395IllinoisProvider IdentifiersIDDescriptionIssuerID364526905DescriptionOtherIssuerTAX ID#IllinoisID560898DescriptionOtherIssuerHEALTHLINK PROVIDER ID#IllinoisID8432060DescriptionOtherIssuerBCBS PROVIDER ID #Illinois