Provider Demographics
NPI:1124007885
Name:MOHRLE, ANDREA C (MSPT JSCC)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:C
Last Name:MOHRLE
Suffix:
Gender:F
Credentials:MSPT JSCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W BAY DR NW STE 208B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4310
Mailing Address - Country:US
Mailing Address - Phone:360-456-4798
Mailing Address - Fax:
Practice Address - Street 1:1801 W BAY DR NW STE 208B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4310
Practice Address - Country:US
Practice Address - Phone:360-456-4798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007852225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF102437Medicaid
WA0147413OtherLABOR & INDUST
WAGAB21484Medicare ID - Type Unspecified
WAF102437Medicaid