Provider Demographics
NPI:1558993717
Name:MICK, ANDREA NICHOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICHOLE
Last Name:MICK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MARGARETTA ST APT 105
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-2890
Mailing Address - Country:US
Mailing Address - Phone:740-605-9446
Mailing Address - Fax:
Practice Address - Street 1:5500 MARGARETTA ST APT 105
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-2890
Practice Address - Country:US
Practice Address - Phone:740-605-9446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist