Provider Demographics
NPI:1982990776
Name:PERCIVAL, ANNE RENE (LMT,MMP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:RENE
Last Name:PERCIVAL
Suffix:
Gender:F
Credentials:LMT,MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15850 N THOMPSON PEAK PKWY APT 2010
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2120
Mailing Address - Country:US
Mailing Address - Phone:480-343-8024
Mailing Address - Fax:
Practice Address - Street 1:15850 N THOMPSON PEAK PKWY APT 2010
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2120
Practice Address - Country:US
Practice Address - Phone:480-343-8024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-09364225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist