Provider Demographics
NPI:1740419654
Name:ANDERSON, LISA ANDREA (CMT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANDREA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27342
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-7342
Mailing Address - Country:US
Mailing Address - Phone:559-270-3791
Mailing Address - Fax:
Practice Address - Street 1:1901 FULTON ST.
Practice Address - Street 2:#110
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721
Practice Address - Country:US
Practice Address - Phone:559-270-3791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist