Provider Demographics
NPI:1154656825
Name:ANDERSON, LENA BETH
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:BETH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NE 2ND ST
Mailing Address - Street 2:UNIT #124
Mailing Address - City:DANIA
Mailing Address - State:FL
Mailing Address - Zip Code:33004
Mailing Address - Country:US
Mailing Address - Phone:305-522-4022
Mailing Address - Fax:
Practice Address - Street 1:3020 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4312
Practice Address - Country:US
Practice Address - Phone:947-772-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA33618225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist