Provider Demographics
NPI:1679634422
Name:ANDREJKO, PAULA (PT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:ANDREJKO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7116 MEYER RD
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7843
Mailing Address - Country:US
Mailing Address - Phone:803-547-2390
Mailing Address - Fax:
Practice Address - Street 1:200 BRICKSTONE SQ
Practice Address - Street 2:SUITE 301
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1437
Practice Address - Country:US
Practice Address - Phone:610-925-1185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPT12174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12174Medicare PIN