Provider Demographics
NPI:1487988317
Name:ANDERSON, BARBARA S (LMT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:S
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MADISON CT
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2130
Mailing Address - Country:US
Mailing Address - Phone:419-823-1072
Mailing Address - Fax:419-823-1072
Practice Address - Street 1:425 MADISON CT
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2130
Practice Address - Country:US
Practice Address - Phone:419-230-4567
Practice Address - Fax:419-230-4567
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13798225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist