Provider Demographics
NPI:1821874405
Name:ANDERSON, CATRINA (LMT, LMM)
Entity Type:Individual
Prefix:
First Name:CATRINA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMT, LMM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 GOLDMAN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-4129
Mailing Address - Country:US
Mailing Address - Phone:803-884-0300
Mailing Address - Fax:
Practice Address - Street 1:7013 EVANS TOWN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-5117
Practice Address - Country:US
Practice Address - Phone:706-364-7958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9661225700000X
GA009533225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist