Provider Demographics
NPI:1639549983
Name:ANDRUS, SYLVIA (PTA)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:ANDRUS
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 1:20 S BLACKHAWK ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-2623
Mailing Address - Country:US
Mailing Address - Phone:608-741-2020
Mailing Address - Fax:
Practice Address - Street 1:3400 N COUNTRY HIGHWAY F
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545
Practice Address - Country:US
Practice Address - Phone:608-757-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2344-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant