Provider Demographics
NPI:1114372794
Name:MAGNESS, ANDREA (PTA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MAGNESS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21185 E JEFFERSON CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-7416
Mailing Address - Country:US
Mailing Address - Phone:720-255-8595
Mailing Address - Fax:
Practice Address - Street 1:21185 E JEFFERSON CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-7416
Practice Address - Country:US
Practice Address - Phone:720-255-8595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13738225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant