Provider Demographics
NPI:1477784130
Name:WOOD, ANDREA L (PT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:WOOD
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 1:4220 132ND ST SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8999
Mailing Address - Country:US
Mailing Address - Phone:425-357-9380
Mailing Address - Fax:425-357-9382
Practice Address - Street 1:2701 171ST PL NE
Practice Address - Street 2:SUITE 203
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-4739
Practice Address - Country:US
Practice Address - Phone:360-386-7401
Practice Address - Fax:360-386-7402
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305206090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0301162OtherL & I
WA0301169OtherL & I
WA0301209OtherL & I
WA0301158OtherL & I
WA0328504OtherL & I
WAG8914005Medicare PIN
WAG8914004Medicare PIN