Provider Demographics
NPI:1710657721
Name:D'ANDREA, CARRIE JO
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:JO
Last Name:D'ANDREA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 LEMKE ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15722-6945
Mailing Address - Country:US
Mailing Address - Phone:814-505-8956
Mailing Address - Fax:
Practice Address - Street 1:165 LEMKE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTOWN
Practice Address - State:PA
Practice Address - Zip Code:15722-6945
Practice Address - Country:US
Practice Address - Phone:814-505-8956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer