Provider Demographics
NPI:1194041970
Name:KROLLMAN, ANDREA (PT)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:KROLLMAN
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 1:2119 POST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5657
Mailing Address - Country:US
Mailing Address - Phone:203-259-7177
Mailing Address - Fax:203-256-9217
Practice Address - Street 1:2119 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5657
Practice Address - Country:US
Practice Address - Phone:203-259-7177
Practice Address - Fax:203-256-9217
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist