Provider Demographics
NPI:1164731972
Name:ANDERSON, RENEE VANESSA (LMT,CRC,LDT)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:VANESSA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMT,CRC,LDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7969 CINCINNATI DAYTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-6637
Mailing Address - Country:US
Mailing Address - Phone:513-225-7130
Mailing Address - Fax:
Practice Address - Street 1:7969 CINCINNATI DAYTON RD STE B
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069
Practice Address - Country:US
Practice Address - Phone:513-225-7130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
OH33.015126225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist