Provider Demographics
NPI:1255829743
Name:KURLAND, ANDREA (CMT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:KURLAND
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:TASHE
Other - Middle Name:ANDREA
Other - Last Name:KURLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:511 S SPRING ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:406 W STANDLEY ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4348
Practice Address - Country:US
Practice Address - Phone:707-391-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51524225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist