Provider Demographics
NPI:1346047875
Name:ANDERSON, ANDREW JUSTIN (LMT, PTA)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JUSTIN
Last Name:ANDERSON
Suffix:
Gender:
Credentials:LMT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 N CENTER
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:UT
Mailing Address - Zip Code:84327-0103
Mailing Address - Country:US
Mailing Address - Phone:435-512-5256
Mailing Address - Fax:
Practice Address - Street 1:92 N CENTER
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:UT
Practice Address - Zip Code:84327-0103
Practice Address - Country:US
Practice Address - Phone:435-512-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9634705225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist