Provider Demographics
NPI:1922843713
Name:ANZIVINO, JUNIPER SARAH (LMT)
Entity type:Individual
Prefix:
First Name:JUNIPER
Middle Name:SARAH
Last Name:ANZIVINO
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 1:16038 ALFORD DR
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-4503
Mailing Address - Country:US
Mailing Address - Phone:225-284-5465
Mailing Address - Fax:
Practice Address - Street 1:1234 DEL ESTE AVE BLDG 3
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4828
Practice Address - Country:US
Practice Address - Phone:225-243-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA9933225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist