Provider Demographics
NPI:1316273915
Name:ANDERSON, BRITTANY COLETTE (LMT)
Entity type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:COLETTE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 W EMERALD ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5003
Mailing Address - Country:US
Mailing Address - Phone:208-344-3744
Mailing Address - Fax:208-344-1222
Practice Address - Street 1:7447 W EMERALD ST
Practice Address - Street 2:SUITE 150
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5003
Practice Address - Country:US
Practice Address - Phone:208-344-3744
Practice Address - Fax:208-344-1222
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007006251172M00000X
IDMX090119172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist