Provider Demographics
NPI:1073605978
Name:LOVE, ANDREA KRISTINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:KRISTINE
Last Name:LOVE
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 1:6500 6TH AVE NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5099
Mailing Address - Country:US
Mailing Address - Phone:206-755-9995
Mailing Address - Fax:
Practice Address - Street 1:6500 6TH AVE NW STE A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-5099
Practice Address - Country:US
Practice Address - Phone:206-755-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA179367OtherDEPT OF LABOR & INDUSTRY
WA8931795OtherCRIME VICTIMS
WA8381568Medicaid
WA5748LOOtherREGENCE BLUE SHIELD
WAA024OtherTRICARE
WA8801130Medicare ID - Type UnspecifiedPIERCE COUNTY
WA8851147Medicare ID - Type UnspecifiedKING COUNTY