Provider Demographics
NPI:1619624715
Name:HEROD, ANDREA ROSE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:ROSE
Last Name:HEROD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4339 KATIE KIM LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8454
Mailing Address - Country:US
Mailing Address - Phone:423-584-1575
Mailing Address - Fax:
Practice Address - Street 1:2745 EXECUTIVE PARK NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2723
Practice Address - Country:US
Practice Address - Phone:423-584-1575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant