Provider Demographics
NPI:1518253780
Name:MOORE, ANDREA (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:GRUNBURGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5130 WILSON BLVD
Mailing Address - Street 2:#B1
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-1169
Mailing Address - Country:US
Mailing Address - Phone:703-527-9557
Mailing Address - Fax:
Practice Address - Street 1:5130 WILSON BLVD
Practice Address - Street 2:#B1
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205
Practice Address - Country:US
Practice Address - Phone:703-527-9557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-25
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052069682251X0800X
WAPT60555417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic