Provider Demographics
NPI:1366153892
Name:SOMAN, ANNA BOONE (RMT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:BOONE
Last Name:SOMAN
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 REED BLVD
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2423
Mailing Address - Country:US
Mailing Address - Phone:206-595-4092
Mailing Address - Fax:
Practice Address - Street 1:131 REED BLVD
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2423
Practice Address - Country:US
Practice Address - Phone:206-595-4092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80913225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA80913OtherCALIFORNIA MASSAGE THERAPY COUNCIL (CAMTC)