Provider Demographics
NPI:1134551658
Name:ANDERSON, RICK (CMT)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3569 ROCKING HORSE CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-8815
Mailing Address - Country:US
Mailing Address - Phone:925-858-8065
Mailing Address - Fax:
Practice Address - Street 1:12811-A ALCOSTA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583
Practice Address - Country:US
Practice Address - Phone:925-858-8065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist