Provider Demographics
NPI:1689765588
Name:DAVIS, ANDREA N (MPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:N
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17134 BEL RAY PL
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-5331
Mailing Address - Country:US
Mailing Address - Phone:816-226-4011
Mailing Address - Fax:816-524-6115
Practice Address - Street 1:1004 PROGRESS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-6326
Practice Address - Country:US
Practice Address - Phone:913-351-3838
Practice Address - Fax:913-351-3939
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010017119225100000X
KS11-04531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4370056OtherMEDICARE PTAN
KS1689765588OtherBCBS KS
KSKA2868024OtherMEDICARE PTAN
45792042OtherBCBS KC