Provider Demographics
NPI:1588677793
Name:BLOCH, ANDREA LYNN (PT, MA)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LYNN
Last Name:BLOCH
Suffix:
Gender:F
Credentials:PT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29001 CEDAR RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4062
Mailing Address - Country:US
Mailing Address - Phone:440-461-6600
Mailing Address - Fax:440-461-6140
Practice Address - Street 1:29001 CEDAR RD
Practice Address - Street 2:SUITE 500
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-4062
Practice Address - Country:US
Practice Address - Phone:440-461-6600
Practice Address - Fax:440-461-6140
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0816595Medicaid
OH000000134667OtherANTHEM INDIV PIN
OH341586636-00OtherBUREAU OF WORKERS COMPENS
OH000000166668OtherANTHEM GROUP PIN
OH341586636-00OtherBUREAU OF WORKERS COMPENS