Provider Demographics
NPI:1174830657
Name:CONAHAN, ANDREA M (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:CONAHAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:BRANDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1262 WOOD LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1769
Mailing Address - Country:US
Mailing Address - Phone:215-741-9315
Mailing Address - Fax:215-741-9317
Practice Address - Street 1:1262 WOOD LN
Practice Address - Street 2:SUITE 102
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1769
Practice Address - Country:US
Practice Address - Phone:215-741-9315
Practice Address - Fax:215-741-9317
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027811250001Medicaid
PA1027811250001Medicaid