Provider Demographics
NPI:1376995969
Name:HERRON, ANNA ROSE (LMT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ROSE
Last Name:HERRON
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 1:15176 SW CANYON WREN WAY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-1396
Mailing Address - Country:US
Mailing Address - Phone:503-871-8973
Mailing Address - Fax:
Practice Address - Street 1:909 N BEECH ST UNIT 209
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1260
Practice Address - Country:US
Practice Address - Phone:503-871-8973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18404225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist