Provider Demographics
NPI:1538360771
Name:ANDERSON, DONNA MARIE (LMT)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIE
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 1:1342 TIMBERLANE RD
Mailing Address - Street 2:SUITE 102-B
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1762
Mailing Address - Country:US
Mailing Address - Phone:850-893-6868
Mailing Address - Fax:950-894-7023
Practice Address - Street 1:1342 TIMBERLANE RD
Practice Address - Street 2:SUITE 102-B
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1762
Practice Address - Country:US
Practice Address - Phone:850-893-6868
Practice Address - Fax:950-894-7023
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA12316174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC5358OtherBLUE CROSS BLUE SHIELD
FLMA12316OtherMASSAGE LICENSE NUMBER