Provider Demographics
NPI:1528474368
Name:ANDERSON, JAMES ROGER (LMT,CNMT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROGER
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LMT,CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MAIN ST,
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01360
Mailing Address - Country:US
Mailing Address - Phone:413-498-0178
Mailing Address - Fax:413-498-0178
Practice Address - Street 1:70 MAIN ST,
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MA
Practice Address - Zip Code:01360
Practice Address - Country:US
Practice Address - Phone:413-498-0178
Practice Address - Fax:413-498-0178
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA#2253225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist