Provider Demographics
NPI:1124185202
Name:ANDERSON, ROSEMARY A (LMP)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S L ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-1725
Mailing Address - Country:US
Mailing Address - Phone:360-374-5550
Mailing Address - Fax:360-374-9598
Practice Address - Street 1:232 WILLOW AVENUE
Practice Address - Street 2:
Practice Address - City:FORKS
Practice Address - State:WA
Practice Address - Zip Code:98333
Practice Address - Country:US
Practice Address - Phone:360-374-5550
Practice Address - Fax:360-374-9598
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005182225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00005182OtherLICENSED MASSAGE PRACTION
WA0074430OtherL & I NUMBER