Provider Demographics
NPI:1730933847
Name:ANDERSON, AMBREE (TRT)
Entity type:Individual
Prefix:
First Name:AMBREE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:TRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 N DIGITAL DR
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6651
Mailing Address - Country:US
Mailing Address - Phone:385-374-5600
Mailing Address - Fax:
Practice Address - Street 1:2750 N DIGITAL DR
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-6651
Practice Address - Country:US
Practice Address - Phone:385-374-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10088198-4003225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist