Provider Demographics
NPI:1225367352
Name:WILLIAMSEN, ANA MARIA (LMT)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:WILLIAMSEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 STAFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-5449
Mailing Address - Country:US
Mailing Address - Phone:321-302-8224
Mailing Address - Fax:
Practice Address - Street 1:262 E MERRITT ISLAND CSWY
Practice Address - Street 2:SUITE 18
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3675
Practice Address - Country:US
Practice Address - Phone:321-459-2032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-20
Last Update Date:2009-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA14374225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist