Provider Demographics
NPI:1750847398
Name:CARLEY, ANNA CHRISTINE (LMT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:CHRISTINE
Last Name:CARLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:CHRISTINE
Other - Last Name:TUDOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1730 22ND AVE APT W204
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2949
Mailing Address - Country:US
Mailing Address - Phone:815-814-3207
Mailing Address - Fax:
Practice Address - Street 1:6738 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-5507
Practice Address - Country:US
Practice Address - Phone:206-789-0289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60924419225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist