Provider Demographics
NPI:1831508282
Name:ANDERSEN, MARIANNE (ATC)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11932 CYPRESS CANYON RD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-5722
Mailing Address - Country:US
Mailing Address - Phone:858-382-9342
Mailing Address - Fax:
Practice Address - Street 1:200 RIVERVIEW PKWY
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-5821
Practice Address - Country:US
Practice Address - Phone:858-382-9342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000137532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer