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General NPI Number Information
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NPI Number | 1699580357
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Entity Type | Individual
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Provider Name | KRISTINA RENEE ANDERSON LMT
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Gender | Female
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 1900 NE HIGHWAY 99W STE L
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City | MCMINNVILLE
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State | OR
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Zip | 97128-2757
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Country | US
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Telephone | 971-237-2840
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Fax |
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Provider Business Mailing Address
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Address Line | 1145 SW CYPRESS ST UNIT 96
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City | MCMINNVILLE
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State | OR
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Zip | 97128-8683
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Country | US
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Telephone | 971-237-2840
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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 | 18442
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License Number State | OR
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