Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Ethan Anderson, DPT

Individual provider Physical Therapist · NPI 1063966554

Ethan Anderson, DPT is a Physical Therapist in Private Practice in Peoria, Arizona. Qualified in 2016, 10 years ago. Practices with Foothills Sports Medicine and Rehabilitation LLC, a 173-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
10
Licensed in
AZ
In the registry since
2016
Specialties on file
3
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

7707 W Deer Valley Rd Ste 100
Peoria, AZ 85382-2101
Phone: (623) 376-9100
Fax: (623) 376-9141
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 12383 (AZ)
Sports Physical Therapist Taxonomy 2251S0007X
Orthopedic Physical Therapist Taxonomy 2251X0800X

Record details

NPI number1063966554
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorNo
NPI enumeratedAugust 12, 2016
Last updated in NPPESAugust 12, 2016
Mailing address15410 S Mountain Pkwy, Suite 112, Phoenix, AZ 85044-6691

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Foothills Sports Medicine And Rehabilitation Llc — 173 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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