Provider Demographics
NPI:1962845230
Name:ANDERS, DEE DEE (LMT)
Entity Type:Individual
Prefix:
First Name:DEE DEE
Middle Name:
Last Name:ANDERS
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 1:135 MADISON ST NE
Mailing Address - Street 2:MTN RIVER MUSCULAR THERAPY
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1238
Mailing Address - Country:US
Mailing Address - Phone:505-321-3219
Mailing Address - Fax:
Practice Address - Street 1:135 MADISON ST NE
Practice Address - Street 2:MTN RIVER MUSCULAR THERAPY
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1238
Practice Address - Country:US
Practice Address - Phone:505-321-3219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6086225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist