Provider Demographics
NPI:1497931190
Name:ANDERSON, NADIA SWAIN (LMT)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:SWAIN
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 1:13 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:FORT MEADE
Mailing Address - State:FL
Mailing Address - Zip Code:33841-3303
Mailing Address - Country:US
Mailing Address - Phone:863-285-6888
Mailing Address - Fax:863-285-7888
Practice Address - Street 1:13 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FORT MEADE
Practice Address - State:FL
Practice Address - Zip Code:33841-3303
Practice Address - Country:US
Practice Address - Phone:863-285-6888
Practice Address - Fax:863-285-7888
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 42221225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist