Provider Demographics
NPI:1477647774
Name:WEST, ANDREA (LMT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 MEDICAL WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5412
Mailing Address - Country:US
Mailing Address - Phone:863-314-9991
Mailing Address - Fax:863-314-0057
Practice Address - Street 1:3201 MEDICAL WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5412
Practice Address - Country:US
Practice Address - Phone:863-314-9991
Practice Address - Fax:863-314-0057
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA17462225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist