Provider Demographics
NPI:1740636679
Name:HURTADO, ANAHI M (LMP)
Entity type:Individual
Prefix:
First Name:ANAHI
Middle Name:M
Last Name:HURTADO
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 1:16515 MERIDIAN E
Mailing Address - Street 2:103B
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6251
Mailing Address - Country:US
Mailing Address - Phone:253-548-5523
Mailing Address - Fax:
Practice Address - Street 1:16515 MERIDIAN E
Practice Address - Street 2:103B
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6251
Practice Address - Country:US
Practice Address - Phone:253-548-5523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60632480172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist