Provider Demographics
NPI:1457782278
Name:ANCHOR, TARJA (LMT)
Entity Type:Individual
Prefix:
First Name:TARJA
Middle Name:
Last Name:ANCHOR
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 1:2600 BEHAN RD
Mailing Address - Street 2:SUITE E2
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-2224
Mailing Address - Country:US
Mailing Address - Phone:815-814-7695
Mailing Address - Fax:
Practice Address - Street 1:2600 BEHAN RD
Practice Address - Street 2:SUITE E2
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-2224
Practice Address - Country:US
Practice Address - Phone:815-814-7695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.014335225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist