Provider Demographics
NPI:1184123358
Name:PROSSER, ANNE (LMT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:PROSSER
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 1:200 HEROUX BLVD UNIT 1408
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-2382
Mailing Address - Country:US
Mailing Address - Phone:401-692-6906
Mailing Address - Fax:
Practice Address - Street 1:144 WATERMAN ST STE 1
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2126
Practice Address - Country:US
Practice Address - Phone:401-692-6906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMT02408225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist