Provider Demographics
NPI:1003926734
Name:MCBRIDE, ANDREA JUNE (PT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JUNE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05494-9773
Mailing Address - Country:US
Mailing Address - Phone:802-879-5726
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-2450
Practice Address - Fax:802-847-3756
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist