Provider Demographics
NPI:1417523796
Name:CARNES, ANDREA PAIGE (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:PAIGE
Last Name:CARNES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 NEW GROVE RD
Mailing Address - Street 2:
Mailing Address - City:SMITHS GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:42171-8269
Mailing Address - Country:US
Mailing Address - Phone:270-246-1145
Mailing Address - Fax:
Practice Address - Street 1:111 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SMITHS GROVE
Practice Address - State:KY
Practice Address - Zip Code:42171-8239
Practice Address - Country:US
Practice Address - Phone:270-563-2084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist