MEDICARE: DANIEL RAY ANDERSON L.M.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA00022310	WA

General Provider Information

NPI Number	:	1144408733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL RAY ANDERSON L.M.T.

Provider Business Mailing Address
First Line	:	1812 N WASHINGTON ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-4757
Country	:	US
Telephone Number	:	509-998-3440
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 N WASHINGTON ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-4757
Country	:	US
Telephone Number	:	509-998-3440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	02/06/2008

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