Provider Demographics
NPI:1134698079
Name:ROOT, NEREA ANASTASIA (LMT)
Entity Type:Individual
Prefix:MS
First Name:NEREA
Middle Name:ANASTASIA
Last Name:ROOT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:NATHAN
Other - Middle Name:ANDREW
Other - Last Name:ROOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2606 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98905
Mailing Address - Country:US
Mailing Address - Phone:206-536-4995
Mailing Address - Fax:
Practice Address - Street 1:160 ROY ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109
Practice Address - Country:US
Practice Address - Phone:206-453-4137
Practice Address - Fax:206-267-0814
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60900789225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist