Provider Demographics
NPI:1114206703
Name:ANDRADE, CHARISSE (PT)
Entity Type:Individual
Prefix:
First Name:CHARISSE
Middle Name:
Last Name:ANDRADE
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 1:6246 TIGERFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-2600
Mailing Address - Country:US
Mailing Address - Phone:813-455-2612
Mailing Address - Fax:
Practice Address - Street 1:6246 TIGERFLOWER CT
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-2600
Practice Address - Country:US
Practice Address - Phone:813-455-2612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 26730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist