Provider Demographics
NPI:1275542680
Name:RAFFERTY, ANDREA LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LYNN
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:LYNN
Other - Last Name:DE PALMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4042 WERTHERS CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7462
Mailing Address - Country:US
Mailing Address - Phone:703-691-3242
Mailing Address - Fax:
Practice Address - Street 1:4042 WERTHERS CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7462
Practice Address - Country:US
Practice Address - Phone:703-691-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203883225100000X
NJ40QA00878400225100000X
NY022739-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist