Provider Demographics
NPI:1508154295
Name:ANDERSON, TANJA (LMT)
Entity Type:Individual
Prefix:
First Name:TANJA
Middle Name:
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 1:621 STEMMERS RUN RD
Mailing Address - Street 2:C
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3386
Mailing Address - Country:US
Mailing Address - Phone:443-621-8289
Mailing Address - Fax:
Practice Address - Street 1:1631 CAPE MAY RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-1612
Practice Address - Country:US
Practice Address - Phone:443-621-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04340225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist