Provider Demographics
NPI:1548627581
Name:HERSHBERGER, ANITA JOY
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:JOY
Last Name:HERSHBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11314 4TH AVE W STE 103
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-6926
Mailing Address - Country:US
Mailing Address - Phone:425-355-3739
Mailing Address - Fax:
Practice Address - Street 1:11314 4TH AVE W STE 103
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-6926
Practice Address - Country:US
Practice Address - Phone:425-355-3739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60605791225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist