Provider Demographics
NPI:1215138912
Name:ANDERSON, KEVIN M (CSCS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S MORTON AVE
Mailing Address - Street 2:APT A20
Mailing Address - City:MORTON
Mailing Address - State:PA
Mailing Address - Zip Code:19070-2059
Mailing Address - Country:US
Mailing Address - Phone:610-457-8422
Mailing Address - Fax:
Practice Address - Street 1:144 S MORTON AVE
Practice Address - Street 2:APT A20
Practice Address - City:MORTON
Practice Address - State:PA
Practice Address - Zip Code:19070-2059
Practice Address - Country:US
Practice Address - Phone:610-457-8422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist