Provider Demographics
NPI:1073886529
Name:IVEY, ANDREA KAY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KAY
Last Name:IVEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 N CARROLL AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1015 N CARROLL AVE
Practice Address - Street 2:STE 104
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6613
Practice Address - Country:US
Practice Address - Phone:214-887-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1214862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist