Provider Demographics
NPI:1396105680
Name:ANDERSON THERAPEUTIC MASSAGE
Entity type:Organization
Organization Name:ANDERSON THERAPEUTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEDICAL MASSAGE THERPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-981-5662
Mailing Address - Street 1:112 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-5224
Mailing Address - Country:US
Mailing Address - Phone:985-981-5662
Mailing Address - Fax:
Practice Address - Street 1:1720 STUMPF BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-3923
Practice Address - Country:US
Practice Address - Phone:985-981-5662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5018172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty