Provider Demographics
NPI:1891988580
Name:ANDERSON, ELIZABETH ANN (LMT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
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 1:2341 BOWEN RD
Mailing Address - Street 2:P.O. BOX 157
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-9415
Mailing Address - Country:US
Mailing Address - Phone:716-655-3129
Mailing Address - Fax:716-655-3129
Practice Address - Street 1:2341 BOWEN RD
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:NY
Practice Address - Zip Code:14059-9415
Practice Address - Country:US
Practice Address - Phone:716-655-3129
Practice Address - Fax:716-655-3129
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-25
Last Update Date:2007-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009814225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist