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General NPI Number Information
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NPI Number | 1346047875
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Entity Type | Individual
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Provider Name | ANDREW JUSTIN ANDERSON LMT, PTA
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Gender | Male
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 67 E 100 N
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City | LOGAN
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State | UT
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Zip | 84321-4624
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Country | US
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Telephone | 435-512-5256
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Fax |
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Provider Business Mailing Address
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Address Line | 92 N CENTER
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City | NEWTON
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State | UT
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Zip | 84327-0103
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Country | US
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Telephone | 435-512-5256
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 9634705
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License Number State | UT
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