MEDICARE: JULIA ANDREA ANDERSON LMP,CPT

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

General Provider Information

NPI Number	:	1194050732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA ANDREA ANDERSON LMP,CPT

Provider Business Mailing Address
First Line	:	118 N LIBERTY ST
Second Line	:	SUITE A & D
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-4322
Country	:	US
Telephone Number	:	360-457-7374
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 N LIBERTY ST
Second Line	:	SUITE A & D
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-4322
Country	:	US
Telephone Number	:	360-457-7374
Fax Number	:

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

Provider Enumeration Date	:	10/15/2009
Last Update Date	:	10/15/2009

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