Provider Demographics
NPI:1134470313
Name:ANDERSON, CHERYL R (LMT, CMMP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:R
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMT, CMMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-5224
Mailing Address - Country:US
Mailing Address - Phone:985-981-5662
Mailing Address - Fax:
Practice Address - Street 1:112 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5224
Practice Address - Country:US
Practice Address - Phone:985-981-5662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5018225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist