Provider Demographics
NPI:1568268571
Name:ANDERSON, MARTIKA (LMT)
Entity type:Individual
Prefix:
First Name:MARTIKA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 SW 13TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3442
Mailing Address - Country:US
Mailing Address - Phone:541-728-0689
Mailing Address - Fax:
Practice Address - Street 1:516 SW 13TH ST STE 102
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3442
Practice Address - Country:US
Practice Address - Phone:541-639-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28424225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist