Provider Demographics
NPI:1205258506
Name:DE ROOVER, ANNA-THERESA MARIA (LMT)
Entity type:Individual
Prefix:
First Name:ANNA-THERESA
Middle Name:MARIA
Last Name:DE ROOVER
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 1:61114 DEER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2581
Mailing Address - Country:US
Mailing Address - Phone:541-420-1698
Mailing Address - Fax:
Practice Address - Street 1:61114 DEER VALLEY DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2581
Practice Address - Country:US
Practice Address - Phone:541-420-1698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19190225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist