Provider Demographics
NPI:1194050732
Name:ANDERSON, JULIA ANDREA (LMP,CPT)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ANDREA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMP,CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N LIBERTY ST
Mailing Address - Street 2:SUITE A & D
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-4322
Mailing Address - Country:US
Mailing Address - Phone:360-457-7374
Mailing Address - Fax:
Practice Address - Street 1:118 N LIBERTY ST
Practice Address - Street 2:SUITE A & D
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-4322
Practice Address - Country:US
Practice Address - Phone:360-457-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist