Provider Demographics
NPI:1730195926
Name:ANDREWS, DANA (PT)
Entity type:Individual
Prefix:MR
First Name:DANA
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S FAIRMONT AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-5106
Mailing Address - Country:US
Mailing Address - Phone:209-369-7745
Mailing Address - Fax:209-369-0004
Practice Address - Street 1:801 S FAIRMONT AVE STE 7
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5106
Practice Address - Country:US
Practice Address - Phone:209-369-7745
Practice Address - Fax:209-369-0004
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 6170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT61700Medicare UPIN