Provider Demographics
NPI:1154448165
Name:HERBERT, ANDREA N (PT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:N
Last Name:HERBERT
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 1:878 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-3910
Mailing Address - Country:US
Mailing Address - Phone:251-344-4212
Mailing Address - Fax:251-344-4302
Practice Address - Street 1:878 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3910
Practice Address - Country:US
Practice Address - Phone:251-344-4212
Practice Address - Fax:251-344-4302
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 16545225100000X
ALPTH5702174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY909YOtherBCBS OF FLORIDA
FLY906DOtherBCBS OF FLORIDA
FLY906DOtherBCBS OF FLORIDA
FLY909YOtherBCBS OF FLORIDA
FL889298900Medicaid