Provider Demographics
NPI:1689807778
Name:SPEAR, ANDREA JILL (RPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JILL
Last Name:SPEAR
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 ROSEMONT DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-4219
Mailing Address - Country:US
Mailing Address - Phone:423-304-4101
Mailing Address - Fax:423-304-1556
Practice Address - Street 1:3207 ROSEMONT DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-4219
Practice Address - Country:US
Practice Address - Phone:423-304-4101
Practice Address - Fax:423-304-1556
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist