Provider Demographics
NPI:1477763381
Name:GARDNER, ANN ELIZABETH (LMT)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:ELIZABETH
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:ANN
Other - Middle Name:ELIZABETH
Other - Last Name:KEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1116 17TH ST.
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221
Mailing Address - Country:US
Mailing Address - Phone:360-708-3072
Mailing Address - Fax:360-755-9163
Practice Address - Street 1:1116 17TH ST. ANACORTES WA 98221
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221
Practice Address - Country:US
Practice Address - Phone:360-293-6277
Practice Address - Fax:360-350-5916
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA15540225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0152422OtherL&I NUMBER
WAMA15540OtherMASSAGE LICENSE #