Provider Demographics
NPI:1962097642
Name:ANDERSON, CARRIE (RYT200)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RYT200
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15517 W IRONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8825
Mailing Address - Country:US
Mailing Address - Phone:602-989-0106
Mailing Address - Fax:
Practice Address - Street 1:15517 W IRONWOOD ST
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8825
Practice Address - Country:US
Practice Address - Phone:602-989-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner