Provider Demographics
NPI:1538139142
Name:MCCARRON, ANDREA RAE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:RAE
Last Name:MCCARRON
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 1:6105 S VENITA CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2514
Mailing Address - Country:US
Mailing Address - Phone:605-357-0077
Mailing Address - Fax:
Practice Address - Street 1:101 W 69TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2438
Practice Address - Country:US
Practice Address - Phone:605-331-0044
Practice Address - Fax:605-331-0088
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist