Provider Demographics
NPI:1871952705
Name:ANDERSON, WARREN (LMT)
Entity type:Individual
Prefix:MR
First Name:WARREN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13362 DIGGINS DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-4029
Mailing Address - Country:US
Mailing Address - Phone:907-345-4918
Mailing Address - Fax:907-345-4918
Practice Address - Street 1:737 WEST 5TH AVENUE SUITE 202
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501
Practice Address - Country:US
Practice Address - Phone:907-240-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-20
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101346225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist