Provider Demographics
NPI:1578842837
Name:ENGLISH, ANDREA BETH (LMT)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:BETH
Last Name:ENGLISH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 STARLITE DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-4425
Mailing Address - Country:US
Mailing Address - Phone:270-312-9550
Mailing Address - Fax:
Practice Address - Street 1:404 STARLITE DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-4425
Practice Address - Country:US
Practice Address - Phone:270-312-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3875225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY-3875OtherKENTUCKY BOARD OF LICENSURE, MASSAGE THERAPIST LICENSE