Healthcare Provider Details

I. General information

NPI: 1528474368
Provider Name (Legal Business Name): JAMES ROGER ANDERSON LMT.,CNMT.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MAIN ST,
NORTHFIELD MA
01360
US

IV. Provider business mailing address

70 MAIN ST,
NORTHFIELD MA
01360
US

V. Phone/Fax

Practice location:
  • Phone: 413-498-0178
  • Fax: 413-498-0178
Mailing address:
  • Phone: 413-498-0178
  • Fax: 413-498-0178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number#2253
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: