Provider Demographics
NPI:1467119248
Name:ANDERSON, DONNA M (LMT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:ANDERSON
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 1:4771 GLENDALE MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3819
Mailing Address - Country:US
Mailing Address - Phone:513-469-9440
Mailing Address - Fax:513-469-1880
Practice Address - Street 1:4771 GLENDALE MILFORD RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-3819
Practice Address - Country:US
Practice Address - Phone:513-469-9440
Practice Address - Fax:513-469-1880
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.009454225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist