Provider Demographics
NPI:1467599829
Name:ANDERSON, CHARLOTTE RENEE (LMT)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:RENEE
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 1:190 DAISY ST # A
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-8687
Mailing Address - Country:US
Mailing Address - Phone:859-325-0247
Mailing Address - Fax:
Practice Address - Street 1:584 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-2401
Practice Address - Country:US
Practice Address - Phone:859-734-9992
Practice Address - Fax:859-734-9929
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1270225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY43354200OtherNCBTMB