Healthcare Provider Details

I. General information

NPI: 1063582856
Provider Name (Legal Business Name): SANDRA KAY ANDERSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 KIMBALL AVE SUITE B
WATERLOO IA
50702-5760
US

IV. Provider business mailing address

1709 PARKER ST
CEDAR FALLS IA
50613-4628
US

V. Phone/Fax

Practice location:
  • Phone: 319-236-2737
  • Fax:
Mailing address:
  • Phone: 319-266-7941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number02713
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: