Provider Demographics
NPI:1629494307
Name:DURANTE, ANDREA ROSE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ROSE
Last Name:DURANTE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4434
Mailing Address - Country:US
Mailing Address - Phone:602-406-3181
Mailing Address - Fax:602-406-6108
Practice Address - Street 1:10245 N 92ND ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4563
Practice Address - Country:US
Practice Address - Phone:480-767-0555
Practice Address - Fax:480-704-3373
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ903651Medicaid
AZZ166847Medicare PIN