Provider Demographics
NPI:1598323792
Name:HEBERT, ANDREA R (PTA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:HEBERT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:R
Other - Last Name:FULCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:1534 E RAY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4429
Mailing Address - Country:US
Mailing Address - Phone:480-855-5542
Mailing Address - Fax:480-855-5756
Practice Address - Street 1:1534 E RAY RD STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4429
Practice Address - Country:US
Practice Address - Phone:480-855-5542
Practice Address - Fax:480-855-5756
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8955A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation