Provider Demographics
NPI:1437580131
Name:ANDERSON, ROBIN BELLANTONI (LMT, NCTMB)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:BELLANTONI
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 TALBOT CT
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2956
Mailing Address - Country:US
Mailing Address - Phone:443-417-5494
Mailing Address - Fax:
Practice Address - Street 1:103 CHESAPEAKE PARK PLZ
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-4201
Practice Address - Country:US
Practice Address - Phone:410-682-1595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM03558225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist