Provider Demographics
NPI:1386121127
Name:VERMEIRE, ANDREW J (LMT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:VERMEIRE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 WILLIWA CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4158
Mailing Address - Country:US
Mailing Address - Phone:570-220-8483
Mailing Address - Fax:
Practice Address - Street 1:207 E NORTHERN LIGHTS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-222-9905
Practice Address - Fax:907-222-9925
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK124750225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist