Provider Demographics
NPI:1336213909
Name:ANDERSON, LORI L (LMP)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11628 OLALLA VALLEY RD SE
Mailing Address - Street 2:
Mailing Address - City:OLALLA
Mailing Address - State:WA
Mailing Address - Zip Code:98359-0023
Mailing Address - Country:US
Mailing Address - Phone:253-861-0850
Mailing Address - Fax:
Practice Address - Street 1:10100 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2302
Practice Address - Country:US
Practice Address - Phone:253-861-0850
Practice Address - Fax:253-983-9747
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010877225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist