Provider Demographics
NPI:1154658599
Name:ANDERMAN, LORI (MA00022804)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ANDERMAN
Suffix:
Gender:F
Credentials:MA00022804
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4423 POINT FOSDICK DR NW STE 310
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1794
Mailing Address - Country:US
Mailing Address - Phone:253-851-5900
Mailing Address - Fax:253-851-5910
Practice Address - Street 1:4423 POINT FOSDICK DR NW STE 310
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1794
Practice Address - Country:US
Practice Address - Phone:253-851-5900
Practice Address - Fax:253-851-5910
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022804225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist