Provider Demographics
NPI:1528410586
Name:SPAULDING, ANDREA (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SPAULDING
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 1:12555 LAKEWOOD BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2771
Mailing Address - Country:US
Mailing Address - Phone:562-923-4704
Mailing Address - Fax:562-923-6709
Practice Address - Street 1:12555 LAKEWOOD BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2771
Practice Address - Country:US
Practice Address - Phone:562-923-4704
Practice Address - Fax:562-923-6709
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2913492251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic