Provider Demographics
NPI:1841565918
Name:ROBERTS, ANDREJ JAMES (LMP)
Entity Type:Individual
Prefix:
First Name:ANDREJ
Middle Name:JAMES
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4537 S G ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-6642
Mailing Address - Country:US
Mailing Address - Phone:253-228-7457
Mailing Address - Fax:
Practice Address - Street 1:4537 S G ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-6642
Practice Address - Country:US
Practice Address - Phone:253-228-7457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60275805225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist