Provider Demographics
NPI:1124192968
Name:SAXE, ANDRA MAYA (MPT)
Entity Type:Individual
Prefix:
First Name:ANDRA
Middle Name:MAYA
Last Name:SAXE
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 1:2575 E BIDWELL ST STE 160
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6446
Mailing Address - Country:US
Mailing Address - Phone:916-932-1210
Mailing Address - Fax:
Practice Address - Street 1:2575 E BIDWELL ST STE 160
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6446
Practice Address - Country:US
Practice Address - Phone:916-932-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT247132251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT247130Medicare ID - Type UnspecifiedMEDICARE PROVIDER