Provider Demographics
NPI:1578044756
Name:CEDENO-TOBON, ANDREA CORALIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CORALIE
Last Name:CEDENO-TOBON
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 1:1860 EL CAMINO REAL STE 201
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3111
Mailing Address - Country:US
Mailing Address - Phone:650-259-8009
Mailing Address - Fax:650-259-9769
Practice Address - Street 1:1860 EL CAMINO REAL STE E
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3127
Practice Address - Country:US
Practice Address - Phone:650-259-8009
Practice Address - Fax:650-259-9769
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist