Provider Demographics
NPI:1417398702
Name:ANDERSON, ARIEL (LMT)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ARIEL
Other - Middle Name:M
Other - Last Name:GRAMNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:11012 GRAVELLY LAKE DR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1332
Mailing Address - Country:US
Mailing Address - Phone:253-584-0183
Mailing Address - Fax:
Practice Address - Street 1:11012 GRAVELLY LAKE DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1332
Practice Address - Country:US
Practice Address - Phone:253-584-0183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60340114225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0312877OtherL&I
WAMA60340114OtherWA STATE DEPT. HEALTH