Provider Demographics
NPI:1013736909
Name:ANTHONY, AREANA L (CMT)
Entity type:Individual
Prefix:
First Name:AREANA
Middle Name:L
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6727 WOODLEY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-5955
Mailing Address - Country:US
Mailing Address - Phone:818-714-4458
Mailing Address - Fax:
Practice Address - Street 1:6727 WOODLEY AVE APT 2
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-5955
Practice Address - Country:US
Practice Address - Phone:818-714-4458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86530225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty