Provider Demographics
NPI:1699103887
Name:ANDERSON, LORIAN
Entity type:Individual
Prefix:
First Name:LORIAN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 BALTIMORE AVE
Mailing Address - Street 2:301
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1059
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6309 BALTIMORE AVE
Practice Address - Street 2:301
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1059
Practice Address - Country:US
Practice Address - Phone:301-699-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3778225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant