Provider Demographics
NPI:1518700558
Name:MATTILA, ANNA LISA (LMT, CNA)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:LISA
Last Name:MATTILA
Suffix:
Gender:F
Credentials:LMT, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16501 NE 15TH AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-4205
Mailing Address - Country:US
Mailing Address - Phone:360-713-8380
Mailing Address - Fax:
Practice Address - Street 1:5501 NE 109TH CT STE L
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6174
Practice Address - Country:US
Practice Address - Phone:360-713-8380
Practice Address - Fax:360-891-8000
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60294790225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist