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General NPI Number Information
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NPI Number | 1790583144
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Entity Type | Individual
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Provider Name | ANNALIE VIRGINIA DERN LMT
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Gender | Female
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 1916 23RD AVE S STE A
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City | SEATTLE
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State | WA
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Zip | 98144-4616
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Country | US
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Telephone | 206-390-6088
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Fax |
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Provider Business Mailing Address
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Address Line | 3938 1/2 INTERLAKE AVE N
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City | SEATTLE
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State | WA
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Zip | 98103-8132
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Country | US
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Telephone | 630-486-5849
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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 | MT137444
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA61635291
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License Number State | WA
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