Provider Demographics
NPI:1306844378
Name:ANDREW, GRETCHEN L (PT)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:L
Last Name:ANDREW
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 1:103 DAVIS RD
Mailing Address - Street 2:STE M
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2731
Mailing Address - Country:US
Mailing Address - Phone:281-338-6777
Mailing Address - Fax:281-338-6778
Practice Address - Street 1:103 DAVIS RD
Practice Address - Street 2:STE M
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2731
Practice Address - Country:US
Practice Address - Phone:281-338-6777
Practice Address - Fax:281-338-6778
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2008-08-13
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
TX11323062251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0225Medicare ID - Type UnspecifiedPROVIDER NUMBER