Provider Demographics
NPI:1710339676
Name:POWELL, ANDREA (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:325 LAFAYETTE RD STE 1
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:NH
Practice Address - Zip Code:03874-4561
Practice Address - Country:US
Practice Address - Phone:978-572-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22340225100000X
NH4865225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist