Provider Demographics
NPI:1558775841
Name:MULDER, ANDREA (PT, DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:MULDER
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 PORTSMOUTH AVE STE A1A
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-4415
Mailing Address - Country:US
Mailing Address - Phone:603-580-4494
Mailing Address - Fax:603-580-4495
Practice Address - Street 1:118 PORTSMOUTH AVE STE A1A
Practice Address - Street 2:
Practice Address - City:STRATHAM
Practice Address - State:NH
Practice Address - Zip Code:03885-4415
Practice Address - Country:US
Practice Address - Phone:603-580-4494
Practice Address - Fax:603-580-4495
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH21362251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic