Provider Demographics
NPI:1164293353
Name:MERRILL, ANDRIA LINN (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ANDRIA
Middle Name:LINN
Last Name:MERRILL
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 KRATZ LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1407
Mailing Address - Country:US
Mailing Address - Phone:607-794-8946
Mailing Address - Fax:
Practice Address - Street 1:1700 ENVOY CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1822
Practice Address - Country:US
Practice Address - Phone:607-794-8946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004221-012255A2300X
IN36003847A2255A2300X
KYAT21472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer