Provider Demographics
NPI:1083621775
Name:TAYLOR, ANDREA M (MS,PT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 KAELEPULU DR APT D
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3355
Mailing Address - Country:US
Mailing Address - Phone:808-277-6167
Mailing Address - Fax:808-261-6440
Practice Address - Street 1:354 KAELEPULU DR APT D
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3355
Practice Address - Country:US
Practice Address - Phone:808-277-6167
Practice Address - Fax:808-261-6440
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH100272Medicare UPIN