Provider Demographics
NPI:1497391213
Name:VANAMBURG, ABBIE RAE (LMT)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:RAE
Last Name:VANAMBURG
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 1:1921 US HIGHWAY 223
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1242
Mailing Address - Country:US
Mailing Address - Phone:517-263-2900
Mailing Address - Fax:517-263-9250
Practice Address - Street 1:1921 US HIGHWAY 223
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1242
Practice Address - Country:US
Practice Address - Phone:517-263-2900
Practice Address - Fax:517-263-9250
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501006554225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist