Provider Demographics
NPI:1083666044
Name:DEXTER, ANDREA N (MPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:N
Last Name:DEXTER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 ASHLEY CIR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3339
Mailing Address - Country:US
Mailing Address - Phone:270-793-0395
Mailing Address - Fax:270-793-0765
Practice Address - Street 1:1777 ASHLEY CIR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3339
Practice Address - Country:US
Practice Address - Phone:270-793-0395
Practice Address - Fax:270-793-0765
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT004206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY87001541Medicaid
KY5027305Medicare ID - Type UnspecifiedMEDICARE #